Pediatric infratentorial subdural empyema: A case report

Abstract

Background: Infratentorial subdural empyemas in children are extremely rare and potentially lethal intracranial infections. Delay in diagnosis and therapy is associated with increased morbidity and mortality.

Case description: A 4-year-old boy presented with cerebellar signs following a failed treatment of otitis media. Imaging studies revealed a subdural empyema and left transverse and sigmoid sinus thrombosis. The empyema was evacuated operatively and antibiotic treatment was initiated and administered for 6 weeks. The patient recovered fully and was discharged 4 weeks following the evacuation of the empyema.

Conclusion: While prompt identification and treatment of subdural infratentorial empyemas are crucial for favorable outcomes, their diagnosis in children might be initially missed. This is, in part because they are so rare and in part, because imaging artifacts arising from the complex posterior fossa anatomy may obscure their presence in the computer tomography (CT) scan. Therefore, high level of suspicion is necessary, given the appropriate history and clinical presentation. In children, this is a recent history of protracted otitis media and central nervous system symptomatology-cerebellar or other.

Keywords: Child; empyema; infratentorial; pediatric; subdural.

Figure 1

CT scan illustrating the extent and the location of the suppurative collection. (a) Transverse plane; (b) sagittal plane reconstruction; (c) coronal plane reconstruction

Figure 2

Preoperative MRV showing the deficient filling of the left transverse and sigmoid sinuses

Figure 3

Postoperative (26 days following the operation) MRI (T1 weighted) documenting the successful evacuation of the purulent collection. (a) Transverse plane; (b) sagittal plane; (c) coronal plane