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Lee WJ, Tsai MH, Hsu JF, Chu SM, Chen CC, Yang PH, Huang HR, Chi MC, Lee CW, Ou-Yang MC. The Epidemiology, Management and Therapeutic Outcomes of Subdural Empyema in Neonates with Acute Bacterial Meningitis. Antibiotics (Basel) 2024; 13:377. [PMID: 38667053 PMCID: PMC11047628 DOI: 10.3390/antibiotics13040377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024] Open
Abstract
Background: Subdural empyema is one of the more serious complications of bacterial meningitis and therapeutic challenges to clinicians. We aimed to evaluate the clinical characteristics, treatment, and outcome of subdural empyema in neonates with bacterial meningitis. Methods: A retrospective cohort study was conducted in two medical centers in Taiwan that enrolled all cases of neonates with subdural empyema after bacterial meningitis between 2003 and 2020. Results: Subdural empyema was diagnosed in 27 of 153 (17.6%) neonates with acute bacterial meningitis compared with cases of meningitis without subdural empyema. The demographics and pathogen distributions were comparable between the study group and the controls, but neonates with subdural empyema were significantly more likely to have clinical manifestations of fever (85.2%) and seizure (81.5%) (both p values < 0.05). The cerebrospinal fluid results of neonates with subdural empyema showed significantly higher white blood cell counts, lower glucose levels and higher protein levels (p = 0.011, 0.003 and 0.006, respectively). Neonates with subdural empyema had a significantly higher rate of neurological complications, especially subdural effusions and periventricular leukomalacia. Although the final mortality rate was not increased in neonates with subdural empyema when compared with the controls, they were often treated much longer and had a high rate of long-term neurological sequelae. Conclusions: Subdural empyema is not uncommon in neonates with acute bacterial meningitis and was associated with a high risk of neurological complications, although it does not significantly increase the final mortality rate. Close monitoring of the occurrence of subdural empyema is required, and appropriate long-term antibiotic treatment after surgical intervention may lead to optimized outcomes.
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Affiliation(s)
- Wei-Ju Lee
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Chiayi 613, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (M.-H.T.); (J.-F.H.); (S.-M.C.); (C.-C.C.); (P.-H.Y.); (H.-R.H.)
| | - Ming-Horng Tsai
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (M.-H.T.); (J.-F.H.); (S.-M.C.); (C.-C.C.); (P.-H.Y.); (H.-R.H.)
- Division of Neonatology and Pediatric Hematology/Oncology, Department of Pediatrics, Chang Gung Memorial Hospital, Yunlin 638, Taiwan
| | - Jen-Fu Hsu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (M.-H.T.); (J.-F.H.); (S.-M.C.); (C.-C.C.); (P.-H.Y.); (H.-R.H.)
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Shih-Ming Chu
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (M.-H.T.); (J.-F.H.); (S.-M.C.); (C.-C.C.); (P.-H.Y.); (H.-R.H.)
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Chih-Chen Chen
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (M.-H.T.); (J.-F.H.); (S.-M.C.); (C.-C.C.); (P.-H.Y.); (H.-R.H.)
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Peng-Hong Yang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (M.-H.T.); (J.-F.H.); (S.-M.C.); (C.-C.C.); (P.-H.Y.); (H.-R.H.)
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan; (M.-C.C.); (C.-W.L.)
| | - Hsuan-Rong Huang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (M.-H.T.); (J.-F.H.); (S.-M.C.); (C.-C.C.); (P.-H.Y.); (H.-R.H.)
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
| | - Miao-Ching Chi
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan; (M.-C.C.); (C.-W.L.)
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan
| | - Chiang-Wen Lee
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan; (M.-C.C.); (C.-W.L.)
- Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi 61363, Taiwan
| | - Mei-Chen Ou-Yang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; (M.-H.T.); (J.-F.H.); (S.-M.C.); (C.-C.C.); (P.-H.Y.); (H.-R.H.)
- Division of Pediatric Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
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2
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Wang W, Maciel CB, Blatt J, Chang PM, Peek GJ, Machado DS. After the storm: Extracorporeal membrane oxygenation after hemicraniectomy in a child. Perfusion 2024; 39:624-626. [PMID: 36600179 DOI: 10.1177/02676591221151037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Ventricular arrhythmias following neurological injury have been attributed to sympathetic surge in subarachnoid hemorrhage and traumatic brain injury. Despite associated risks of bleeding and thrombosis, veno-arterial extracorporeal membrane oxygenation (ECMO) in critically ill, clinically unstable postoperative neurosurgical patients can be lifesaving. In the context of neurological injury and the neurosurgical population, the literature available regarding ECMO utilization is limited, especially in children. We report a case of successful ECMO utilization in a child with malignant ventricular tachycardia after decompressive craniectomy for refractory intracranial hypertension following evacuation of extensive subdural empyema.
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Affiliation(s)
- Wei Wang
- Department of Pediatrics, Division of Pediatric Critical Care, University of Florida, Gainesville, FL, USA
| | - Carolina B Maciel
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Florida, Gainesville, FL, USA
- Department of Neurology, Division of Neurocritical Care, University of Florida, Gainesville, FL, USA
| | - Jason Blatt
- Department of Neurosurgery, Division of Pediatric Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Philip M Chang
- Congenital Heart Center, Department of Pediatrics, Division of Pediatric Cardiology, University of Florida, Gainesville, FL, USA
| | - Giles J Peek
- Congenital Heart Center, Department of Cardiothoracic Surgery, University of Florida, Gainesville, FL, USA
| | - Desiree S Machado
- Department of Pediatrics, Division of Pediatric Critical Care, University of Florida, Gainesville, FL, USA
- Department of Pediatrics, Division of Cardiology and Pediatric Cardiac Critical Care, Jackson Memorial Hospital, University of Miami, Miami, FL, USA
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3
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Choi S, Park TH, Lee HJ, Kim TH, Joo JD, Huh J, Chung YN, Heo ST, Kim ET, Rhim JK. Subdural Empyema from Streptococcus suis Infection, South Korea. Emerg Infect Dis 2024; 30:616-619. [PMID: 38407167 PMCID: PMC10902535 DOI: 10.3201/eid3003.231018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024] Open
Abstract
In Jeju Island, South Korea, a patient who consumed raw pig products had subdural empyema, which led to meningitis, sepsis, and status epilepticus. We identified Streptococcus suis from blood and the subdural empyema. This case illustrates the importance of considering dietary habits in similar clinical assessments to prevent misdiagnosis.
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4
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América Silva A, Zão I, Louro JA, Pereira E, Monteiro E. From Pansinusitis to Cerebritis Due to Eikenella corrodens. Cureus 2024; 16:e54864. [PMID: 38533169 PMCID: PMC10964727 DOI: 10.7759/cureus.54864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/28/2024] Open
Abstract
Meningitis is a rare but possible complication of sinusitis. We present a case of a 21-year-old woman with a history of fever, headache and nasal obstruction who presented at the emergency department with psychomotor agitation. Orotracheal intubation and invasive mechanical ventilation were given to protect airway. Blood analysis showed leukocytosis and elevated C-reactive protein. Cerebral and maxillofacial computed tomography (CT) demonstrated pansinusitis with gas foci more prominent in the left frontal sinus with an area of bone rarefaction on the posterior wall with possible communication with the cranial cavity. Lumbar puncture was performed. Empirical antibiotic and corticosteroid therapy were started. Neurosurgery (NC) and Ear Nose and Throat (ENT) surgeons declined indication for urgent surgery and she was admitted at General ICU. On the fourth day of hospitalization, a brain magnetic resonance imaging (CE-MRI) was performed, revealing subdural empyema and cerebritis adjacent to the frontal sinus. She was transferred to the reference neurosurgical center for surgical interventions and was admitted post-operatively at the Neurocritical Care Unit (NCCU). Reevaluation MRI showed residual anterior frontal empyema and absence of focus control in peri-nasal sinusitis, requiring a new ENT surgery. A Streptococcus spp was isolated from the blood, Eikenella corrodens from the pus collected from the sinuses, and the CSF was sterile. The patient completed 21 days of antibiotic therapy. She was extubated on the 19th day, with Broca's aphasia and right hemiparesis, and on the 23rd day transferred to the ENT Service and later to the Rehabilitation Service. We present a case of atypical central nervous system (CNS) infection by a rare agent, highlighting the importance of vigilance, focus control, and neurocritical care. In a severe and complex manifestation like this, the management typically involves medical and surgical interventions. Subdural empyema should be treated as a neurosurgical emergency due to the potential rapid deterioration in patient's neurological condition, attributed to secondary damage. In this case, brain multimodal monitoring, was very helpful in acute phase management. Neurocritical care teams should be involved early in patients with this presentation of CNS infection to provide optimal management, reducing complications and secondary brain lesions therefore improving patient outcomes.
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Affiliation(s)
| | - Inês Zão
- Intensive Care Medicine, Centro Hospitalar do Tâmega e Sousa, Penafiel, PRT
| | - João A Louro
- Intensive Care Medicine, Hospital Prof. Doutor Fernando Fonseca, Amadora, PRT
| | - Eduarda Pereira
- Neurocritical Care, Intensive Care Medicine, Hospital São João, Porto, PRT
| | - Elisabete Monteiro
- Intensive Care Medicine, Centro Hospitalar Universitário de São João, Porto, PRT
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5
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Eça R, Graça A, Francisco R, Pamplona J. Subdural Empyema as a Complication of Sinusitis: A Diagnosis to Keep in Mind. Cureus 2024; 16:e53249. [PMID: 38425583 PMCID: PMC10904082 DOI: 10.7759/cureus.53249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/02/2024] Open
Abstract
Subdural empyema (SDE) is a rare form of intracranial infection associated with a high morbidity and mortality rate. Infections of the middle ear and paranasal sinuses are the most common predisposing factors that can lead to bacterial proliferation in the subdural space, usually by direct extension in young patients. Clinicians must have a high level of suspicion for patients presenting with concomitant neurological deficits and signs of sinus pathology. Cross-sectional imaging is mandatory for the diagnosis, preferably contrast-enhanced magnetic resonance imaging. Treatment requires a prolonged course of intravenous antibiotherapy and prompt neurosurgical drainage intervention. Here, we present the case of a 20-year-old patient with long-term neurological sequelae following a left paranasal infection complicated by an SDE. This case report highlights the rapid progression and devastating consequences of SDE, an ominous neurosurgical emergency.
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Affiliation(s)
- Rosário Eça
- Internal Medicine, Centro Hospitalar de Lisboa Central, Lisboa, PRT
| | - Armando Graça
- Critical Care, Centro Hospitalar de Lisboa Central, Lisboa, PRT
| | - Rita Francisco
- Critical Care, Centro Hospitalar de Lisboa Central, Lisboa, PRT
| | - Jaime Pamplona
- Radiology, Centro Hospitalar de Lisboa Central, Lisboa, PRT
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6
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Aguilar Mora HM, Soto Barraza JC. Cryptogenic Epidural Cervicothoracic Abscess: A Case Report and Literature Review. Cureus 2024; 16:e52189. [PMID: 38222999 PMCID: PMC10787145 DOI: 10.7759/cureus.52189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2024] [Indexed: 01/16/2024] Open
Abstract
A spinal epidural abscess (SEA) is a rare infection characterized by pus formation in the spinal epidural space, associated with various degrees of motor, sensory, or combined deficits. It is linked to several risk factors and predominantly impacts middle-aged men. This report discusses an atypical case of a patient without any predisposing factors who developed a cervicothoracic SEA associated with significant transverse myelitis. A targeted literature search was conducted on PubMed, Scopus, and SpringerLink, employing terms such as "spinal epidural abscess, subdural empyema, and transverse myelitis." While there are numerous studies on this topic with a multidisciplinary approach, reports of cryptogenic SEA associated with the extensive involvement of cervical and thoracic spinal segments are rare. SEA is a very uncommon condition. Hence, a comprehensive understanding of its clinical presentation is crucial for adopting an appropriate diagnostic approach and delivering timely treatment.
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Alosaimi H, Aljohani K, Alatawi T, Alghabban I, Alatawi F, Alduraibi A, Almithn D, Abdultawab A. Subdural Empyema in Pediatric Bacterial Meningitis: A Case Report. Cureus 2023; 15:e51401. [PMID: 38292966 PMCID: PMC10826629 DOI: 10.7759/cureus.51401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 02/01/2024] Open
Abstract
Bacterial meningitis in pediatric populations presents a formidable challenge, necessitating careful evaluation and swift intervention. The clinical spectrum of pediatric bacterial meningitis requires a clear understanding, considering its diverse presentations, risk factors, and evolving diagnostic and therapeutic approaches. We present the case of an eight-year-old male who presented with an acute onset of fever, severe headache, and vomiting following an upper respiratory tract infection. A physical examination revealed meningeal irritation signs, altered consciousness, and focal seizures. Laboratory results showed elevated inflammatory markers, and cerebrospinal fluid analysis indicated abnormalities. Initial imaging displayed sinus involvement, but the patient's condition deteriorated. Subsequent magnetic resonance imaging revealed subdural empyema and meningoencephalitis. Streptococcus pneumoniae was identified as the causative agent. Subsequently, tailored antibiotic therapy and urgent neurosurgical interventions were initiated. The patient recovered with the resolution of neurological deficits. This case underscores the complexity of pediatric bacterial meningitis and its potential complications, emphasizing the relationship between upper respiratory tract infections, sinus involvement, and meningitis development. A multidisciplinary approach, combining targeted antimicrobial therapy with neurosurgical intervention, proved crucial for optimal management and favorable outcomes. This detailed case report highlights the importance of early diagnosis and comprehensive management in pediatric bacterial meningitis cases.
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Affiliation(s)
| | | | | | | | | | | | - Danah Almithn
- General Practice, King Faisal University, Al-Ahsa, SAU
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8
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Mahmoud A, Beliani T, Alyassin N, Zakharia K, Basil T, Poulad D. Streptococcus intermedius: From a Normal Oral Commensal to a Life-Threatening Organism. Cureus 2023; 15:e50708. [PMID: 38234954 PMCID: PMC10792467 DOI: 10.7759/cureus.50708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/19/2024] Open
Abstract
Subdural empyema is a collection of pus in the subdural space between the dura mater and the arachnoid. It carries very high morbidity and mortality as it can spread anywhere in the brain; however, the risk can be mitigated with appropriate surgical and medical intervention. Being protected by the skull, cranial infections are usually preceded by a significant risk factor, either an external invader such as skull fractures secondary to trauma, penetrating injury, prior surgery, or, more commonly, in more than 50% of cases, due to spread of an internal infection such as ear or sinus infections. Anaerobic and aerobic bacteria can cause subdural empyema. Both gram-positive and gram-negative bacteria are notorious for developing this kind of infection; for example, different groups of gram-positive streptococci and staphylococci, gram-negative Haemophilus influenza, and other gram-negative bacilli can cause subdural empyema. While streptococci are more frequent with sinus infection causing subdural empyema, staphylococci are associated with skin invasion secondary to either head trauma or cranial surgery. Streptococcus intermedius is a gram-positive alpha-hemolytic pathogen belonging to the larger Streptococcus anginosus group that itself is a subgroup from viridans streptococci, aka Streptococcus milleri. Streptococcus intermedius is an oral commensal flora and is considered to be a low-virulence bacteria in immunocompetent patients but can be associated with significant morbidity and mortality. Subdural empyema tends to occur more often in immunocompromised patients such as diabetic patients, those with human immunodeficiency virus infection, and those using immunosuppressive medications. The clinical course ranges from indolent to fulminant. The size and location of the abscess play a role in clinical presentation. Headache is the most common presenting symptom, but patients can also present with fever, nausea, seizure, or altered mental status. Diagnosis can be obtained with CT and MRI scans of the brain. Prompt drainage of the abscess and lengthy antibiotics improve the prognosis significantly. Our case highlights a rare origin of subdural empyema from the direct spread of a skin abscess.
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Affiliation(s)
- Anas Mahmoud
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Tala Beliani
- Oncology, Kansas City University, Kansas City, USA
| | - Nizar Alyassin
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Karam Zakharia
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Taha Basil
- Infectious Disease, St. Joseph's University Medical Center, Paterson, USA
| | - David Poulad
- Neurosurgery, St. Joseph's University Medical Center, Paterson, USA
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Pestelacci S, Hofer-Inteeworn N, Dennler M, Glaus T. Balloon dilation and transient stenting of unilateral membranous choanal atresia in a British Shorthair cat with chronic purulent rhinitis and ascending meningoencephalitis. SCHWEIZ ARCH TIERH 2023; 165:793-800. [PMID: 38014545 DOI: doi.org/10.17236/sat00414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
INTRODUCTION Choanal atresia is a rare congenital anomaly in humans and animals, characterized by the absence of communication of one or both nasal cavities with the nasopharynx. The severity of clinical signs depends on the presence of unilateral versus bilateral stenosis as well as comorbidities. With bilateral atresia, respiration may be severely compromised particularly during sleep, as airflow can only occur when breathing through the open mouth. Various therapeutic modalities have been described in people and adopted for animals. All treatments may be associated with complications, the most important being post-therapeutic scar formation with re-stenosis. This report describes a 10-month-old British Shorthair cat with chronic unilateral serosal nasal discharge that changed to mucopurulent discharge. When acute neurological signs developed, the cat was presented to the veterinary hospital. A diagnosis of primary, membranous right sided choanal atresia was achieved via computed tomography (CT) and nasopharyngeal (posterior) rhinoscopy. Secondary changes included destructive rhinitis with progression to the CNS with a subdural empyema and meningoencephalitis. Retinal changes and aspiration bronchopneumonia were suspected additional complications. After recovery from the secondary infections, the membranous obstruction was perforated and dilated using a valvuloplasty balloon by an orthograde transnasal approach under endoscopic guidance from a retroflexed nasopharyngeal view. To prevent re-stenosis, a foley catheter was placed as a transient stent for 6 days. The cat recovered uneventfully and was asymptomatic after the stent removal. Endoscopic re-examination after 5 months confirmed a persistent opening and patency of the generated right choanal passage. The cat remains asymptomatic 10 months after the procedure. Transnasal endoscopic balloon dilation and transient stenting of choanal atresia is a minimally invasive and relatively simple procedure with potentially sustained success.
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Affiliation(s)
- S Pestelacci
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich
| | - N Hofer-Inteeworn
- Clinic for Small Animal Internal Medicine, Vetsuisse Faculty, University of Zurich
| | - M Dennler
- Clinic of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich
| | - T Glaus
- Division of Cardiology, Vetsuisse Faculty, University of Zurich
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Dutta D, Ahmed S, Borkotoky A. Spontaneous Subdural Empyema: A Case Report. Asian J Neurosurg 2023; 18:823-825. [PMID: 38161606 PMCID: PMC10756828 DOI: 10.1055/s-0043-1777273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Subdural empyema is the collection of purulent material between the dura mater and arachnoid. Subdural empyema most often occurs due to the direct extension of local infection. But spontaneous subdural empyema is a rare entity. In literature, not many cases of spontaneous subdural empyema by Escherichia coli are reported. Here we report a case of spontaneous subdural empyema along with a review of literature who was previously treated on the suspicion of encephalitis with urinary tract infection and then brought to our hospital.
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Affiliation(s)
- Deep Dutta
- Department of Neurosurgery, Apollo Hospitals Guwahati, Guwahati, Assam, India
| | - Shameem Ahmed
- Department of Neurosurgery, Apollo Hospitals Guwahati, Guwahati, Assam, India
| | - Abhigyan Borkotoky
- Department of Neurosurgery, Apollo Hospitals Guwahati, Guwahati, Assam, India
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11
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Milinis K, Thiagarajan J, Leong S, De S, Sinha A, Sharma R, Sharma S. Review of management practices of sinogenic intracranial abscesses in children. J Laryngol Otol 2023; 137:1135-1140. [PMID: 36751894 DOI: 10.1017/s0022215123000166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVE This study aimed to evaluate the management practices and outcomes in children with sinogenic intracranial suppuration. METHOD This was a retrospective cohort study in a single paediatric tertiary unit that included patients younger than 18 years with radiologically confirmed intracranial abscess, including subdural empyema and epidural or intraparenchymal abscess secondary to sinusitis. Main outcomes studied were rate of return to the operating theatre, length of hospital stay, death in less than 90 days and neurological disability at 6 months. RESULTS A cohort of 39 consecutive patients presenting between 2000 and 2020 were eligible for inclusion. Subdural empyema was the most common intracranial complication followed by extradural abscess and intraparenchymal abscess. Mean length of hospital stay was 42 days. Sixteen patients were managed with combined ENT and neurosurgical interventions, 15 patients underwent ENT procedures alone and 4 patients had only neurosurgical drainage. Four patients initially underwent non-operative management. The rates of return to the operating theatre, neurological deficits and 90-day mortality were 19, 9 and 3, respectively, and were comparable across the 4 treatment arms. In the univariate logistic regression, only the size of an intracranial abscess was found be associated with an increased likelihood of return to the operating theatre, whereas combined ENT and neurosurgical intervention did not result in improved outcomes. CONCLUSION Sinogenic intracranial abscesses are associated with significant morbidity and mortality. The size of an intracranial abscess has a strong association with a need for a revision surgery.
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Affiliation(s)
- K Milinis
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - J Thiagarajan
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
- School of Medicine, University of Liverpool, Liverpool, UK
| | - S Leong
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - S De
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - A Sinha
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - R Sharma
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
| | - S Sharma
- Department of Paediatric Otolaryngology, Alder Hey Children's Hospital, Liverpool, UK
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12
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Hutton D, Kameda-Smith M, Afshari FT, Elawadly A, Hogg F, Mehta S, Samarasekara J, Aquilina K, Jeelani NUO, Tahir MZ, Thompson D, Tisdall MM, Silva AHD, Hatcher J, James G. Intracranial invasive group A streptococcus: a neurosurgical emergency in children. J Neurosurg Pediatr 2023; 32:478-487. [PMID: 37439477 DOI: 10.3171/2023.5.peds23109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/16/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Invasive group A streptococcus (iGAS) infections are associated with a high rate of morbidity and mortality. CNS involvement is rare, with iGAS accounting for only 0.2%-1% of all childhood bacterial meningitis. In 2022, a significant increase in scarlet fever and iGAS was reported globally with a displacement of serotype, causing a predominance of the emm1.0 subtype. Here, the authors report on iGAS-related suppurative intracranial complications requiring neurosurgical intervention and prolonged antibiotic therapy. METHODS The authors performed a retrospective chart review of consecutive cases of confirmed GAS in pediatric neurosurgical patients. RESULTS Five children with a median age of 9 years were treated for intracranial complications of GAS infection over a 2-month period between November 2022 and December 2022. All patients had preceding illnesses, including chicken pox and upper respiratory tract infections. Infections included subdural empyema with associated encephalitis (n = 2), extradural empyema (n = 1), intracranial abscess (n = 1), and diffuse global meningoencephalitis (n = 1). Streptococcus pyogenes was cultured from 4 children, and 2 were of the emm1.0 subtype. Antimicrobial therapy in all patients included a third-generation cephalosporin but varied in adjunctive therapy, often including a toxin synthesis inhibitor antibiotic such as clindamycin. Neurological outcomes varied; 3 patients returned to near neurological baseline, 1 had significant residual neurological deficits, and 1 patient died. CONCLUSIONS Despite the worldwide increased incidence, intracranial complications remain rarely reported resulting in a lack of awareness of iGAS-related intracranial disease. Awareness of intracranial complications of iGAS and prompt referral to a pediatric neurology/neurosurgical center is crucial to optimize neurological outcomes.
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Affiliation(s)
- Dana Hutton
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
- 2School of Medicine, University of Dundee
| | | | - Fardad T Afshari
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
| | - Ahmed Elawadly
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
| | - Florence Hogg
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
| | - Samir Mehta
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
| | - James Samarasekara
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
| | - Kristian Aquilina
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
- 3Great Ormond Street Institute of Child Health, University College London; and
| | - Noor Ul Owase Jeelani
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
- 3Great Ormond Street Institute of Child Health, University College London; and
| | - M Zubair Tahir
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
- 3Great Ormond Street Institute of Child Health, University College London; and
| | - Dominic Thompson
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
- 3Great Ormond Street Institute of Child Health, University College London; and
| | - Martin M Tisdall
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
- 3Great Ormond Street Institute of Child Health, University College London; and
| | - Adikarige Haritha Dulanka Silva
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
- 3Great Ormond Street Institute of Child Health, University College London; and
| | - James Hatcher
- 3Great Ormond Street Institute of Child Health, University College London; and
- 4Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital, London, United Kingdom
| | - Greg James
- 1Department of Neurosurgery, Great Ormond Street Hospital for Children, London
- 3Great Ormond Street Institute of Child Health, University College London; and
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13
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Sahhar HS, Rubin E, Rishmawi SE, Logan M. Invasive Sinusitis With Arcanobacterium haemolyticum and Fusobacterium necrophorum Complicated by Subdural Empyema in an Immunocompetent Adolescent Patient. Cureus 2023; 15:e44517. [PMID: 37790026 PMCID: PMC10544604 DOI: 10.7759/cureus.44517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
We are reporting a very rare case of an invasive infection with Arcanobacterium haemolyticum and Fusobacterium necrophorum that resulted in meningitis, cerebral edema, and subdural empyema secondary to upper respiratory infection (URI) and sinusitis in an immunocompetent adolescent patient. Our patient is a 17-year-old male with no significant medical history who presented to his pediatrician with a fever for three days, was diagnosed with a viral URI, and instructed to continue symptomatic care. Seven days later, the patient developed a headache, left-sided weakness, and continued to spike fever. The patient presented to the Emergency Center due to altered mental status, worsening left-sided weakness, and difficulty speaking. Head computed tomography (CT) scan showed small right-sided fluid collection with right-to-left midline shift and marked opacification of paranasal sinuses with air-fluid levels in frontal sinuses. The patient underwent an emergent craniotomy that revealed subdural empyema under high pressure and was started on vancomycin, cefepime, metronidazole, and levetiracetam. Six hours after his craniotomy, the patient developed fixed dilatation of his right-side pupil and a head CT scan showed developing ischemic changes and increased in his midline shift which prompted to emergent right decompressive craniectomy. The following day of his surgery, magnetic resonance imaging of the brain showed large acute infarctions of the right hemisphere, edema, and subfalcine herniation. Two brain death exams - 12 hours apart - were performed in which criteria for brain death were met. The patient's subdural empyema culture grew Fusobacterium necrophorum and Arcanobacterium haemolyticum.
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Affiliation(s)
- Hanna S Sahhar
- Pediatric Intensive Care Unit, Spartanburg Regional Healthcare System, Spartanburg, USA
- Pediatrics, Edward Via College of Osteopathic Medicine, Spartanburg, USA
| | - Erica Rubin
- Pediatrics, Edward Via College of Osteopathic Medicine, Spartanburg, USA
| | - Sami E Rishmawi
- Pediatric Intensive Care Unit, Spartanburg Regional Healthcare System, Spartanburg, USA
- Pediatrics, Edward Via College of Osteopathic Medicine, Spartanburg, USA
| | - Matthew Logan
- Pediatrics, Edward Via College of Osteopathic Medicine, Spartanburg, USA
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14
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Portilla-Skerrett G, Rivera-Ramírez De Arellano P, Santiago-Ortolaza C, Boodoosingh-Casiano D. A Case of Subdural Empyema Due to Dental Pathogen. Cureus 2023; 15:e43666. [PMID: 37724210 PMCID: PMC10505088 DOI: 10.7759/cureus.43666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2022] [Indexed: 09/20/2023] Open
Abstract
Subdural empyema is a rare but serious infection in the brain. Several etiologies and pathological mechanisms have been described. The team reports a case of subdural empyema due to dental pathogens, of which a limited number of cases have been reported. Radiological findings and medical management of this case are reviewed since prompt intervention reduces not only mortality and morbidity but also complications including sepsis, cranial osteomyelitis, and residual neurological deficit, among others.
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15
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Hong CS, Prust ML, Manes RP, Rimmer RA, Omay SB. Subdural empyema secondary to pansinusitis after coronavirus disease 2019 infection in an immunocompetent patient: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22525. [PMID: 36806010 PMCID: PMC10550626 DOI: 10.3171/case22525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/04/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND Superimposed intracranial infection is an uncommon but clinically significant complication in patients with active coronavirus disease 2019 (COVID-19), particularly in those with predisposing immunocompromising conditions. OBSERVATIONS The authors describe a case of subdural empyema, secondary to extension from pansinusitis, in a 20-year-old otherwise healthy immunocompetent male who was recently diagnosed with COVID-19. Despite his critical condition at time of presentation, he made a full clinical recovery with aggressive multidisciplinary surgical management between neurosurgery and otolaryngology, despite negative cultures to guide directed antimicrobial therapy. Ultimately, use of molecular-based polymerase chain reaction testing diagnosed Aspergillus fumigatus as the offending pathogen after the patient had already recovered and was discharged from the hospital. LESSONS This case demonstrates the potential for significant superimposed intracranial infection even in young, healthy individuals, infected by COVID-19 and suggests an aggressive surgical approach to achieve source control, particularly in the absence of positive cultures to guide antimicrobial therapies, may lead to rapid clinical improvement.
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Affiliation(s)
| | - Morgan L. Prust
- Department of Neurology, Division of Neurocritical Care and Emergency Neurology, Yale School of Medicine, New Haven, Connecticut; and
| | - R. Peter Manes
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut
| | - Ryan A. Rimmer
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut
| | - Sacit Bulent Omay
- Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut
- Department of Surgery, Division of Otolaryngology, Yale School of Medicine, New Haven, Connecticut
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16
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Arcalas CJE, Reich DA, Blair SA, Paradise Black NM. Acute Bacterial Sinusitis With Epidural and Subdural Involvement. Cureus 2023; 15:e34849. [PMID: 36923169 PMCID: PMC10008776 DOI: 10.7759/cureus.34849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 02/13/2023] Open
Abstract
Sinusitis is a common childhood infection with potential for rare intracranial complications. These neurologic sequelae can lead to serious morbidity and mortality if not addressed promptly. We describe a case of suspected sinusitis in a 13-year-old male complicated by a superior sagittal sinus thrombosis along with subdural and epidural empyemas.
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Affiliation(s)
| | - Daniel A Reich
- College of Medicine, University of Florida, Gainesville, USA
| | - Samari A Blair
- College of Medicine, University of Florida, Gainesville, USA
| | - Nicole M Paradise Black
- Department of Pediatrics, University of Florida, Gainesville, USA.,College of Medicine, University of Florida, Gainesville, USA
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17
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Makwana M, Merola JP, Bhatti I, Patel CK, Leach PA. Towards improved outcome in children treated surgically for spontaneous intracranial suppuration in South Wales. Br J Neurosurg 2023; 37:45-48. [PMID: 33428472 DOI: 10.1080/02688697.2020.1868403] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Spontaneous central nervous system (CNS) infections in children are rare. Treatment involves surgical intervention and antibiotic therapy. We describe a single centre experience of managing this condition in South Wales. METHODS We performed a retrospective review of surgically managed cases in our unit for patients under 18 years of age between 2008 and 2018. Data were collected regarding aetiology, location, microbiology examination, treatment and outcomes. RESULTS Twenty-six patients were identified of which 25 case notes were available. Fifteen were male and 10 were female. Median age was 12 years (age range 0.3-17 years). Seven patients (28%) had a burr-hole aspiration and 18 (72%) underwent craniotomy. A second procedure was performed in 10 (40%) and a third procedure in two (8%). Fourteen (56%) had a brain abscess, 10 (40%) had subdural empyema (one was bilateral) and one (4%) had an extradural empyema. Fifteen (60%) had a raised WCC (>11.5 × 109/L) and 22 (88%) had a CRP of >10 mg/L at presentation. Three (12%) patients had a normal WCC and CRP at presentation. Overall, 12 (48%) were secondary to sinus infection, with the most common organism being Streptococcus. Seven (28%) were due to otitis media or mastoiditis, six (24%) had no cause identified. The mean number of CT/MRI scans was 6.7 (range 3-13). The mean follow-up period was 16.7 months (range 1-117 months). At last follow up, 19 (76%) had a GOS of 5, five (20%) had a GOS of 4 and one (12%) had GOS of 3. There were no deaths. CONCLUSIONS In Wales, outcomes have improved over time in keeping with other paediatric neurosurgical units in England. Increased availability of imaging resources in our hospital and use of neuro-navigation for all cases in our unit as well as earlier identification of sepsis, communication with microbiologists with dedicated ward rounds and, enhanced identification of causative organisms and contemporary anti-microbials have also contributed towards the improved management of this condition.
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Affiliation(s)
- Milan Makwana
- Department of Paediatric Neurosurgery, University Hospital of Wales & Noah's Ark Children's Hospital, Cardiff, UK
| | - Joseph P Merola
- Department of Paediatric Neurosurgery, University Hospital of Wales & Noah's Ark Children's Hospital, Cardiff, UK
| | - Imran Bhatti
- Department of Paediatric Neurosurgery, University Hospital of Wales & Noah's Ark Children's Hospital, Cardiff, UK
| | - Chirag K Patel
- Department of Paediatric Neurosurgery, University Hospital of Wales & Noah's Ark Children's Hospital, Cardiff, UK
| | - Paul A Leach
- Department of Paediatric Neurosurgery, University Hospital of Wales & Noah's Ark Children's Hospital, Cardiff, UK
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18
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Rebchuk AD, Chang SJ, Griesdale DEG, Honey CR. Non-contrast-enhancing subdural empyema: illustrative case. J Neurosurg Case Lessons 2022; 4:CASE22269. [PMID: 36088564 PMCID: PMC9706330 DOI: 10.3171/case22269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Subdural empyema (SDE) is a life-threatening intracranial infection that, without timely surgical intervention and appropriate antibiotic treatment, is inevitably fatal. SDE is classically recognized on brain imaging as a subdural collection surrounded by a contrast-enhancing ring. OBSERVATIONS The authors describe the case of a 41-year-old male with clinical features consistent with SDE but without any contrast enhancement on multiple computed tomography scans obtained more than 48 hours apart. Given the high clinical suspicion for SDE, a craniotomy was performed that demonstrated frank pus that eventually grew Streptococcus pyogenes. LESSONS This case demonstrates that SDE may present without ring enhancement on contrast-enhanced imaging. In critically ill patients with a high clinical suspicion for SDE despite lack of contrast enhancement, we demonstrate that exploratory burr holes or craniotomy can provide diagnostic confirmation and source control.
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Affiliation(s)
| | | | - Donald E. G. Griesdale
- Department of Anesthesiology, Pharmacology and Therapeutics, and
- Division of Critical Care Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; and
- Center for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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19
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Potruch A, Rosenthal G, Michael-Gayego A, Temper V, Abdelrahman M, Ayalon O, Nir-Paz R, Oster Y. A Case Report of Mycoplasma hominis Subdural Empyema Following Decompressive Craniotomy, and a Review of Central Nervous System Mycoplasma hominis Infections. Front Med (Lausanne) 2022; 9:792323. [PMID: 35280893 PMCID: PMC8908106 DOI: 10.3389/fmed.2022.792323] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/01/2022] [Indexed: 11/22/2022] Open
Abstract
Background Mycoplasma hominis is a small cell-wall-free organism, part of the normal microbiota of the genitourinary tract. It is rarely involved in extragenital infections, mainly joint, surgical-site, and respiratory infections. Methods We describe a case of M. hominis subdural empyema and lower limb surgical site infections, following decompressive craniotomy, after traumatic brain and extremities injury. In addition, a literature review of 34 cases M. hominis CNS infections was done. Results Our case depicts a 25-years old patient who developed subdural empyema and surgical site infections in his cranium and fibula. Both sites were cultured, and small pinpoint colonies grew on blood agar. MALDI-TOF MS identified M. hominis. Simultaneously 16S-rDNA PCR from CSF detected M. hominis. Antimicrobial treatment was switched to doxycycline with improvement. Literature review revealed 21 adults and 13 pediatric cases of M. hominis CNS infection. Risk factors in adults were head trauma, neurosurgery, or post-partum period. Conclusions Based upon the literature reviewed, we postulate that adult patients with head trauma or neurosurgical procedure, rarely are infected either through direct contamination during the trauma, or by undergoing urgent, urinary catheterization, and may experience distant infection due to translocation of M. hominis into the bloodstream. In such cases diagnosis is delayed due to difficulties in growing and identifying the bacteria. Empiric antimicrobials are usually not effective against mycoplasmas. These factors contributed to the mortality in adult cases (15%). Our rare case highlights the necessity of combining classical microbiology routines with advanced molecular techniques to establish a diagnosis in complicated cases.
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Affiliation(s)
- Assaf Potruch
- Department of Internal Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Guy Rosenthal
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Neurosurgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ayelet Michael-Gayego
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Violeta Temper
- Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mohanad Abdelrahman
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Oshrat Ayalon
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ran Nir-Paz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Yonatan Oster
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
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20
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Milinis K, Thompson N, Atsmoni SC, Sharma SD. Sinogenic Intracranial Suppuration in Children: Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2021; 167:215-223. [PMID: 34491863 DOI: 10.1177/01945998211043847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate temporal trends in the management of sinogenic intracranial suppuration and its outcomes in children. DATA SOURCES A systematic search of databases was performed (Medline, Embase, Cochrane, ClinicalTrials.gov). REVIEW METHODS Studies in children (age <18 years) with sinogenic subdural empyema, extradural abscess, and intraparenchymal abscess were included. Data on treatment strategies were extracted. Primary outcome was death <90 days. Secondary outcomes were return to theater, neurologic disability at 6 months, and length of stay. Random effects meta-analysis and meta-regression were performed to investigate the effect of time and endoscopic sinus surgery (ESS) on these outcomes. RESULTS A total of 32 retrospective observational studies involving 533 patients recruited across a 45-year period (1975-2020) were included. The pooled estimates for 90-day mortality, permanent neurologic disability, and return to theater were 2.3% (95% CI, 1.1%-3.6%; I2 = 0, P > .99), 21.3% (95% CI, 15.3%-27.3%; I2 = 75.2%, P < .001), and 37.3% (95% CI, 29.5%-45%; I2 = 71.2%, P < .001), respectively, with no significant differences found across the study period. The pooled estimate for ESS was 58.4% (95% CI, 44.2%-72.6%; I2 = 97.1%, P < .001) with a significantly increasing trend in its use in the more recent years. ESS was not associated with improved mortality, reduced need for revision surgery, or neurologic disability. CONCLUSION The outcomes of sinogenic intracranial complications have not changed over the last 45 years, and ESS was not associated with improved patient outcomes. Further high-quality studies are required to determine the most appropriate treatment modalities to improve the burden of morbidity associated with sinogenic intracranial suppuration in children.
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21
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Sevilla-Acosta F, Ballestero-Pernudi A, Jiménez-Cruz E, Álvarez-Cabalceta H, Naranjo-Zuñiga G. Streptococcus equi subspecies zooepidemicus Meningitis, Septicemia, and Brain Infarcts in a Costa Rican Infant. Cureus 2021; 13:e17286. [PMID: 34552827 PMCID: PMC8448576 DOI: 10.7759/cureus.17286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2021] [Indexed: 11/05/2022] Open
Abstract
Streptococcus equi, an equine commensal bacterium, is a rare etiology of septicemia and meningoencephalitis in humans and is extremely infrequent in children. Scarce literature has been published about its clinical presentation, treatment and outcomes in infants. Here, we describe a case of S. equi subsp. zooepidemicus septicemia and meningoencephalitis in a five-month-old Costa Rican infant that was confirmed by peripheral blood and cerebrospinal fluid (CSF) cultures in a regional hospital of the Pacific coast of Costa Rica who developed multiple ischemic cerebral infarcts secondary to infectious vasculitis, a subdural empyema and serious neurological sequelae. We also reviewed the literature on S. equi meningitis in infants under one year of age. This is the first reported case in our country, the fourth reported in infants under one year of age and the second describing multiple cerebral infarcts and subdural empyema in an infant.
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Affiliation(s)
- Fabricio Sevilla-Acosta
- Pediatrics, Hospital Nacional De Niños "Dr. Carlos Sáenz Herrera", San José, CRI
- Pediatrics, Hospital La Anexión, Nicoya, CRI
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22
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Yeşilbaş O, Tahaoğlu I, Yozgat CY, Duramaz BB, Türel Ö, Tekin N, Uzuner S, Abdallah A. Subdural empyema, brain abscess, and superior sagittal sinus venous thrombosis secondary to Streptococcus anginosus. Turk Arch Pediatr 2021; 56:88-91. [PMID: 34013239 DOI: 10.14744/TurkPediatriArs.2020.03743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/02/2020] [Indexed: 11/20/2022]
Abstract
Streptococcus anginosus can be frequently isolated from brain abscesses, but is a rare cause of the liver, lung, and deep tissue abscesses. In this report, we present a patient with subdural empyema, brain abscess, and superior sagittal cerebral venous thrombosis as complications of rhinosinusitis whose purulent empyema sample yielded S. anginosus. A 13-year-old female patient was referred to our pediatric intensive care unit with altered mental status, aphasia, and behavioral change. On a brain computed tomography scan, subdural empyema extending from the left frontal sinus to the frontal interhemispheric area and left hemispheric dura was detected. Intravenous ceftriaxone, vancomycin, and metronidazole treatments were started. Subdural empyema was surgically drained. Postoperative brain magnetic resonance venography imaging showed superior sagittal sinus thrombosis. Cultures obtained from purulent empyema sample revealed S. anginosus. On the third day of hospitalization, a brain computed tomography scan showed brain edema, especially in the left hemisphere and significantly increased subdural empyema that had been previously drained. She was reoperated and decompressive craniectomy was performed. On the fifth day, partial epileptic seizures occurred. Brain magnetic resonance imaging showed a brain abscess on the interhemispheric area. The magnetic resonance imaging findings of abscess formation improved on 30th day and she was discharged on the 45th day after the completion of antibiotic therapy.
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23
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Otto WR, Paden WZ, Connors M, Joerger T, Buzi A, Rizzi M, Huh J, Storm P, Heuer G, Kennedy B, McGuire J, Swami S, Lang SS. Suppurative Intracranial Complications of Pediatric Sinusitis: A Single-Center Experience. J Pediatric Infect Dis Soc 2021; 10:309-316. [PMID: 32955086 PMCID: PMC8023312 DOI: 10.1093/jpids/piaa101] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 08/28/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Suppurative intracranial complications of sinusitis are rare events in children and can lead to harmful neurologic sequelae and significant morbidity. We sought to review the presentation and management of patients admitted at our hospital with these conditions. METHODS This was a retrospective study of pediatric patients admitted to a quaternary children's hospital from 2007 to 2019 for operative management of sinusitis with intracranial extension. Clinical characteristics, including surgical and microbiological data, were collected and analyzed. RESULTS Fifty-four patients were included; the median age was 11.0 years, and there was a male predominance. Eighty-nine percent of patients had prior healthcare visits for the current episode of sinusitis; 46% of patients had an abnormal neurologic exam on admission. Epidural abscess and subdural empyema were the most common complications, and subdural empyema was associated with repeat surgical intervention. The dominant pathogens were Streptococcus anginosus group organisms (74%). The majority of patients completed treatment parenterally, with a median duration of therapy of 35 days. Neurological sequelae, including epilepsy or ongoing focal deficits, occurred in 22% of patients. History of seizure or an abnormal neurological exam at admission were associated with neurological sequelae. CONCLUSIONS Clinicians should consider intracranial complications of sinusitis in patients with symptoms of sinusitis for >1 week. Patients should undergo urgent neuroimaging, as neurosurgical intervention is essential for these patients. Subdural empyema was associated with repeat neurosurgical intervention. Neurological sequelae occurred in 22% of patients, and new onset seizure or an abnormal neurological exam at admission were associated with neurological sequelae.
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Affiliation(s)
- William R Otto
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - William Z Paden
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Meghan Connors
- Center for Data Driven Discovery in Biomedicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Torsten Joerger
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adva Buzi
- Division of Otolaryngology, Children’s Hospital of Philadelphia, Department of Otolaryngology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Mark Rizzi
- Division of Otolaryngology, Children’s Hospital of Philadelphia, Department of Otolaryngology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jimmy Huh
- Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Phillip Storm
- Center for Data Driven Discovery in Biomedicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Neurosurgery, Children’s Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Gregory Heuer
- Center for Data Driven Discovery in Biomedicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Neurosurgery, Children’s Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Benjamin Kennedy
- Center for Data Driven Discovery in Biomedicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Neurosurgery, Children’s Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jennifer McGuire
- Division of Neurology, Children’s Hospital of Philadelphia, Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sanjeev Swami
- Department of Pediatrics, Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Shih-Shan Lang
- Center for Data Driven Discovery in Biomedicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Division of Neurosurgery, Children’s Hospital of Philadelphia, Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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24
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Benzagmout M, Lakhdar F, Chakour K, Chaoui MEF. Subdural Empyema Complicating a Giant Fronto-Ethmoidal Osteoma. Asian J Neurosurg 2020; 15:737-740. [PMID: 33145243 PMCID: PMC7591205 DOI: 10.4103/ajns.ajns_196_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/18/2020] [Accepted: 06/03/2020] [Indexed: 11/04/2022] Open
Abstract
Osteomas of the paranasal sinuses rarely lead to intracranial manifestations. We present an unusual case of a giant frontal sinus osteoma leading to subdural empyema formation. Determine the origin and the optimal surgical approach of these unusual lesions by analyzing giant osteomas of the frontal and ethmoidal sinuses in the literature. We report a rare case of giant frontoethmoidal osteoma with intracranial extension in a 34-year-old man, revealed by seizures. Neuroradiological studies revealed frontoparietal subdural empyema associated to a large osteoma in the right frontal sinus. The patient underwent surgical evacuation of the empyema and resection of the osteoma in one stage operation of decompressive craniotomy. The patient recovered very well after surgery and postoperative antibiotic therapy. This case represents in the literature only the third-reported case of subdural empyema complicating frontoethmoidal osteoma. The surgical treatment options, including open surgery techniques and endoscopic approaches, as well as pathogenesis are discussed according to the relevant literature.
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Affiliation(s)
- Mohammed Benzagmout
- Department of Neurosurgery, Hassan II Hospital, Medical School of Fez, University Sidi Mohammed Ben Abdellah, Fez, Morocco.,Clinical Science Laboratory, Faculty of Medicine, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Fayçal Lakhdar
- Department of Neurosurgery, Hassan II Hospital, Medical School of Fez, University Sidi Mohammed Ben Abdellah, Fez, Morocco.,Clinical Science Laboratory, Faculty of Medicine, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Khalid Chakour
- Department of Neurosurgery, Hassan II Hospital, Medical School of Fez, University Sidi Mohammed Ben Abdellah, Fez, Morocco
| | - Mohammed El Faiz Chaoui
- Department of Neurosurgery, Hassan II Hospital, Medical School of Fez, University Sidi Mohammed Ben Abdellah, Fez, Morocco
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25
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Abstract
RATIONALE Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases. However, complicated subdural empyema rarely occurs after trepanation and drainage of chronic subdural hematoma. PATIENT CONCERNS A male patient (77 years old) was admitted to the hospital on the 2nd day of fever after an undergoing a "trepanation and drainage of chronic subdural hematoma" operation at a local hospital. After admission, the patient was treated with an emergency operation in which a subdural abscess was diagnosed and then administered antibiotics after the operation. DIAGNOSIS According to the clinical manifestations, intraoperative findings of imaging examination and the results of pus culture, the diagnosis was subdural empyema. INTERVENTION We surgically removed the subdural empyema. Postoperative antibiotics were administered according to the results of bacterial culture. OUTCOMES At 3 months after the operation, the patient returned to the hospital for reexamination and was found to have achieved a good recovery and good self-care. LESSONS Subdural empyema after trepanation and drainage of chronic subdural hematoma is a very rare and severe disease. Early diagnosis and operative intervention as well as the intravenous administration of antibiotics can improve the prognosis of patients and enhance their quality of life.
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Affiliation(s)
- Hang Xue
- Department of Neurotraumatic Surgery, The First Hospital of Jilin University
| | - Weitao Zhang
- Department of Neurotraumatic Surgery, The First Hospital of Jilin University
| | - Lin Shi
- Department of Neurosurgery, The Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Changchun, Jilin
| | - Yiming Zhang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Ji’nan, Shandong
| | - Bing Yu
- Department of Neurosurgery, Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong, China
| | - Hongfa Yang
- Department of Neurotraumatic Surgery, The First Hospital of Jilin University
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Konar S, Gohil D, Shukla D, Sadashiva N, Uppar A, Bhat DI, Srinivas D, Arimappamagan A, Devi BI. Predictors of outcome of subdural empyema in children. Neurosurg Focus 2019; 47:E17. [PMID: 31370020 DOI: 10.3171/2019.5.focus19268] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/21/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to report the etiology, clinical features, microbiology, surgical outcome, and predictors of outcome of spontaneous subdural empyema (SDE). METHODS The authors conducted a retrospective study in a tertiary hospital. Children up to 18 years of age, with a diagnosis of SDE with infective etiology, were included in the present cohort. Patients with posttraumatic, postsurgery, and tubercular origin of SDE were excluded from the study. The Glasgow Outcome Scale was used for outcome assessment at the end of 3 months. For analysis purposes, the demographic data, clinical features, radiological data, microbiology, type of surgery, and complication data were categorized, and univariate and multivariable logistic regression analyses were performed to identify the factors associated with outcome. RESULTS Ninety-eight children were included in the study and the mean age was 10.9 years. Otogenic origin (34.7%) was the most common source of infection, followed by meningitis (14.3%). The mean duration of symptoms was 12 days. Seventy-six children presented with Glasgow Coma Scale (GCS) score > 8 and the supratentorial location was the most common location. Almost 75% of the children underwent craniotomy or craniectomy and the rest had burr-hole evacuation. Beta-hemolytic Streptococcus (10%) was the most common organism isolated. Cerebral venous thrombosis (CVT; 10.2%) was the most frequent complication in this cohort. The other complications were infarction (6.1%), new-onset seizure (4.1%), and bone flap osteomyelitis (4.1%). Thirteen cases had a recurrence of pus collection, which was more common in the craniotomy group than in the burr-hole group. Age (p = 0.02), GCS score ≤ 8 (OR 8.15, p = 0.001), CVT (OR 15.17, p = 0.001), and presence of infarction (OR 7, p = 0.05) were strongly associated with unfavorable outcome. In multivariable logistic regression analysis, only GCS score ≤ 8 (p = 0.01), CVT (p = 0.02), and presence of infarction (p = 0.04) had a significant impact on unfavorable outcome. CONCLUSIONS Prompt diagnosis and immediate intervention is the goal of management of SDE, especially in children as a delay in diagnosis can result in unconsciousness and secondary complications such as CVT and infarction, which adversely affect outcome.
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27
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Abstract
Infectious sinusitis is extremely common in children, and persistent infection can lead to many complications. The most dangerous and commonly reported complications are intracranial. These intracranial complications include pneumocephalus, cerebral abscess, subdural empyema, meningitis, cellulitis, orbital abscess, and cavernous sinus thrombosis. Pneumocephalus is the presence of air in the cranium and sometimes it can lead to intracranial infection and localized pus collection in the potential space between meninges. Herein, we report a case of a 12-year-old girl who presented to a pediatric emergency in a confused and disoriented state. The cerebrospinal fluid (CSF) analysis provided a picture of bacterial meningitis, but her CT scan showed pneumocephalus and subdural empyema. This case report will help clinicians overcome this diagnostic challenge using the appropriate imaging and treatment modalities to prevent neurological sequelae.
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Affiliation(s)
| | - Arsalan Anwar
- Neurology, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Hobab Aslam
- Pediatrics, Sindh Medical College, Karachi, PAK
| | | | - Owais Ur Rehman
- Internal Medicine, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
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28
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Abstract
OBJECTIVE The authors conducted a retrospective analysis of a consecutive series of children with intracranial subdural empyemas (SEs) and epidural abscesses (EAs) to highlight the important clinical difference between these two entities. They describe the delays and pitfalls in achieving accurate diagnoses and make treatment recommendations based on clinical and imaging findings. METHODS They reviewed their experience with children who had presented with intracranial SE and/or EA in the period from January 2013 to May 2018. They recorded presenting complaint, date of presentation, age, neurological examination findings, time from presentation to diagnosis, any errors in initial image interpretation, timing from diagnosis to surgical intervention, type of surgical intervention, neurological outcome, and microbiology data. They aimed to assess possible causes of any delay in diagnosis or surgical intervention. RESULTS Sixteen children with SE and/or EA had undergone evaluation by the authors’ neurosurgical service since 2013. Children with SE (n = 14) presented with unmistakable evidence of CNS involvement with only one exception. Children with EA alone (n = 2) had no evidence of CNS dysfunction. All children older than 1 year of age had sinusitis. The time from initial presentation to a physician to diagnosis ranged from 0 to 21 days with a mean and median of 4.5 and 6 days, respectively. The time from diagnosis to neurosurgical intervention ranged from 0 to 14 days with a mean and median of 3 and 1 day, respectively. Delay in treatment was due to misinterpretation of images, a failure to perform timely imaging, progression on imaging as an indication for surgical intervention, or the managing clinician’s preference. Among the 14 cases with SE, initial imaging studies in 6 were not interpreted as showing SE. Four SE collections were dictated as epidural even on MRI. The only fatality was associated with no surgical intervention. Endoscopic sinus surgery was not associated with reducing the need for repeat craniotomy. CONCLUSIONS Regardless of the initial imaging interpretation, any child presenting with focal neurological deficit or seizures and sinusitis should be assumed to have an SE or meningitis, and a careful review of high-resolution imaging, ideally MRI with contrast, should be performed. If an extraaxial collection is identified, surgical drainage should be performed expeditiously. Neurosurgical involvement and evaluation are imperative to achieve timely diagnoses and to guide management in these critically ill children. ABBREVIATIONS EA = epidural abscess; SE = subdural empyema.
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Affiliation(s)
| | - Christian Kaufman
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and.,3University of Missouri at Kansas City, Kansas City, Missouri
| | - David Garcia
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and.,3University of Missouri at Kansas City, Kansas City, Missouri
| | - Michael D Partington
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and.,3University of Missouri at Kansas City, Kansas City, Missouri
| | - Paul A Grabb
- 1Department of Neurological Surgery, University of Kansas, Kansas City, Kansas; and.,2Children's Mercy Hospital and.,3University of Missouri at Kansas City, Kansas City, Missouri
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29
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Abou-Hanna J, Panning K, Mehta H. Haemophilus influenzae Type f Meningitis Complicated by Bilateral Subdural Empyema, Central Venous Thrombosis, and Bilateral Sensorineural Hearing Loss in an Immunocompetent 12-month-old. Cureus 2019; 11:e4850. [PMID: 31410333 PMCID: PMC6684117 DOI: 10.7759/cureus.4850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Haemophilus influenzae is a gram-negative coccobacillus that colonizes the nasopharyngeal surface and upper respiratory tract of healthy individuals and includes six encapsulated serotypes as well as non-encapsulated, non-typeable strains. Since the widespread use of the Haemophilus influenzae type b (Hib) conjugate vaccine implemented in 1990, the majority of invasive illness now seen in the United States is secondary to capsular serotypes other than type b and non-typeable strains with the largest burden of disease affecting the extremes of age-infants and the elderly. We report a case of acute Haemophilus influenzae type f meningitis in a 12-month-old female who was previously healthy and had been fully immunized. She demonstrated clinical improvement on ceftriaxone, but persistent fever and ear-tugging resulted in obtaining an MRI that displayed bilateral subdural empyemas requiring burr-hole craniotomy, central venous thrombosis requiring anticoagulation, and bilateral sensorineural hearing loss requiring cochlear implants. Immunological studies confirmed immunocompetency and appropriate response to her previous Hib vaccination, suggesting a significant impact of bacterial virulence. These complications, with the exception of sensorineural hearing loss, have not been reported in the literature for Haemophilus influenzae type f and should be considered in the care of these patients despite clinical appearance given the severity of complications and potential for acute decompensation. Despite the success of vaccination in reducing invasive disease, cases of H. influenzae meningitis continue to occur via less common encapsulated serotypes with unknown complications, making the management and treatment of these infections more difficult for practitioners.
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Affiliation(s)
- Jacob Abou-Hanna
- Pediatrics, University of Michigan Medical School, Ann Arbor, USA
| | | | - Hiral Mehta
- Pediatrics, C.S. Mott Children's Hospital, Ann Arbor, USA
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30
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Abstract
A case report of a 94-year-old, previously well male patient who presented with fever thought to be caused by community acquired pneumonia, new unilateral hearing loss and reduced consciousness. Despite antibiotic treatment he continued to deteriorate. Brain imaging with computer tomography and magnetic resonance imaging revealed a left otomastoiditis with osteomyelitis of the skull base, associated with an adjacent subdural empyema. He was also found to have a venous sinus thrombosis, most likely secondary to otitis media. He was managed with intravenous antibiotics, anticoagulation, grommet insertion and a hearing aid and he made a good recovery. This case reminds us to consider otitis media in older patients who present with hearing loss and fever. Otitis media can lead to serious complications including subdural empyema and osteomyelitis of the skull base.
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Affiliation(s)
- Rebecca Cole
- Department of Geratology, John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sanja Thompson
- Department of Geratology, John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sergios Gargalas
- Department of Geratology, John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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31
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Toms J, Kurczewski L, Simonds R, Graham RS, Harrison J. Gram-negative Cranial Bone Flap Infection Treated with Continuous Gentamicin Irrigation: A Case Report. Cureus 2019; 11:e4282. [PMID: 31183265 PMCID: PMC6538237 DOI: 10.7759/cureus.4282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 57-year-old male presented with severely altered mental status in the setting of diabetic ketoacidosis. Neuroimaging revealed two intracranial masses. Days following surgical resection of an olfactory groove meningioma, the patient developed Serratia marcescens bacteremia along with an enlarging epidural and subgaleal fluid collection. Subgaleal fluid aspiration was also positive. The patient later returned to the operating room for wound washout where purulent collections were discovered in the subgaleal, epidural, and left subdural spaces. The wound was evacuated and the bone flap was thoroughly cleansed with betadine and soaked in peroxide prior to replacement. Four drains were placed (two subgaleal and two epidural) with two serving as inlets and two as outlets. Continuous irrigation of the subgaleal and epidural spaces with gentamicin solution was performed for five days. The bone flap was successfully salvaged and the patient was discharged from inpatient rehab three weeks following washout.
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Affiliation(s)
- Jamie Toms
- Neurosurgery, Virginia Commonwealth University Health Systems, Richmond, USA
| | - Lisa Kurczewski
- Neurosurgery, Virginia Commonwealth University Health Systems, Richmond, USA
| | - Robert Simonds
- Neurosurgery, Virginia Commonwealth University Health Systems, Richmond, USA
| | - R Scott Graham
- Neurosurgery, Virginia Commonwealth University Health Systems, Richmond, USA
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32
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Lovett ME, Shah ZS, Moore-Clingenpeel M, Sribnick E, Ostendorf A, Chung MG, Leonard J, O'Brien NF. Intensive care resources required to care for critically ill children with focal intracranial infections. J Neurosurg Pediatr 2018; 22:453-461. [PMID: 30004311 DOI: 10.3171/2018.4.peds17715] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The authors reviewed cases in which children with a focal infection inside the head (ex: a brain abscess) were cared for in their pediatric ICU to describe the frequency of complications and quantify the ICU resources needed (ex: breathing tube, blood pressure medications, and/or an intracranial pressure monitor). This information helps clarify illness severity and has identified complications that we should further investigate to improve care for these children.
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Affiliation(s)
- Marlina E Lovett
- 1Division of Critical Care Medicine, Nationwide Children's Hospital.,2Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine
| | - Zubin S Shah
- 2Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine
| | | | - Eric Sribnick
- 4Division of Neurosurgery, Nationwide Children's Hospital; and
| | - Adam Ostendorf
- 2Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine.,5Division of Neurology, Nationwide Children's Hospital, Columbus, Ohio
| | - Melissa G Chung
- 1Division of Critical Care Medicine, Nationwide Children's Hospital.,2Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine.,5Division of Neurology, Nationwide Children's Hospital, Columbus, Ohio
| | - Jeffrey Leonard
- 4Division of Neurosurgery, Nationwide Children's Hospital; and
| | - Nicole F O'Brien
- 1Division of Critical Care Medicine, Nationwide Children's Hospital.,2Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine
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33
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Abstract
Objective: Both infected subdural hematoma (ISH) and Edwardsiella tarda infections are rare in humans. E. tarda is a motile, facultative anaerobic, gram-negative rod bacterium, which is isolated from fresh or brackish water, but not usually from humans. Extra-intestinal E. tarda infections are rare and might cause severe clinical symptoms. However, ISH caused by E. tarda has not been reported previously. We report the first case of ISH due to E. tarda. Patient: A 76-year-old man was admitted to our hospital with a headache, loss of appetite, and nausea. Computed tomography revealed bilateral subdural hematoma. Results: We performed burr hole drainage. A hematoma with pus was found on the left side and chronic hematoma was found on the right side. Consequently, we diagnosed him with ISH on the left side and chronic subdural hematoma on the right side. E. tarda was detected in a culture from the hematoma with pus on the left side. As postoperative antibiotic therapy, we administered ceftriaxone and metronidazole for 47 days. The patient was discharged with no residual neurological deficit. Conclusion: Our case implied that favorable outcomes can be obtained by drainage and appropriate antibiotic therapy for ISH caused by E. tarda.
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Affiliation(s)
- Takayuki Anno
- Department of Neurosurgery, Tochigi Medical Center Shimotsuga, Japan
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34
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D'Agostino E, Makler V, Bauer DF. Epidural abscess presenting as severe depression with suicidal ideations: Case report. Surg Neurol Int 2018; 9:83. [PMID: 29740504 PMCID: PMC5926216 DOI: 10.4103/sni.sni_52_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/12/2018] [Indexed: 11/04/2022] Open
Abstract
Background Epidural abscess (EDA) is an uncommon form of intracranial infection that generally presents with fever, headache, and focal neurologic deficit. Imaging generally reveals a lentiform collection with diffusion restriction on diffusion weighted image. We present an interesting case in which a patient with EDA presented with three weeks of depression with suicidal ideations. The patient displayed no notable infectious signs and the imaging was suggestive of chronic subdural hematoma (SDH) rather than EDA. Case Description The patient is a 57-year-old man with past medical history significant for epilepsy and left hemiplegia secondary to remote traumatic brain injury who presented with a three-week history of depression, anxiety, and active suicidal ideation, resulting in psychiatric admission to an outside hospital. He had undergone three previous craniotomies for SDH many years ago and had no significant psychiatric history. Magnetic resonance imaging was consistent with subacute right SDH. On presentation, patient was at neurologic baseline and was afebrile with unremarkable labs. Operative findings demonstrated frank purulence in the epidural space. The patient was treated with antibiotics and both depression and suicidal ideations resolved postoperative day 5. Conclusions EDA can present in atypical ways, especially in patients who have undergone previous cranial procedures. Depression is one possible atypical presentation.
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Affiliation(s)
- Erin D'Agostino
- Geisel School of Medicine, New Hampshire, Lebanon, New Hampshire, United States
| | - Vyacheslav Makler
- Section of Neurological Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - David F Bauer
- Section of Neurological Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
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35
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Abstract
RATIONALE A subdural empyema (SDE) following burr hole drainage of a chronic subdural hematoma (CSDH) can be difficult to distinguish from a recurrence of the CSDH, especially when imaging data is limited to a computed tomography (CT) scan. PATIENTS CONCERNS All patients underwent burr hole drainage of the CSDH at first, and the appearance of the SDE occurred within one month. DIAGNOSES A contrast-enhanced magnetic resonance imaging (MRI) scan, with diffusion-weighted imaging (DWI), revealed both the SDE and diffuse meningitis in all patients. INTERVENTIONS In Case 1, because the patient was very young, burr hole drainage of the SDE, rather than craniotomy, was performed. However, subsequent craniotomy was required due to recurrence of the SDE. In Cases 2 and 3, an initial craniotomy was performed without burr hole drainage. OUTCOMES Symptoms improved for all patients, and each was discharged without any neurologic deficits or subsequent recurrence. LESSONS Neurosurgeons should consider the possibility of infection if recurrence of CSDH occurs within 1 month following drainage of a subdural hematoma. A contrast-enhanced MRI with DWI should be performed to differentiate SDE from CSDH. In addition, surgical evacuation of the empyema via wide craniotomy is preferred to burr hole drainage.
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MESH Headings
- Craniotomy/methods
- Diagnosis, Differential
- Diffusion Magnetic Resonance Imaging/methods
- Dimensional Measurement Accuracy
- Drainage/adverse effects
- Drainage/methods
- Empyema, Subdural/diagnosis
- Empyema, Subdural/etiology
- Empyema, Subdural/physiopathology
- Empyema, Subdural/surgery
- Hematoma, Subdural, Chronic/diagnosis
- Hematoma, Subdural, Chronic/surgery
- Humans
- Infant
- Male
- Middle Aged
- Postoperative Complications/diagnosis
- Postoperative Complications/physiopathology
- Postoperative Complications/surgery
- Subdural Space/diagnostic imaging
- Tomography, X-Ray Computed/methods
- Treatment Outcome
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36
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Abstract
Subdural empyema (SDE) is collection of pus in the potential space between the dura and arachnoid layers of the meninges. Leading causes of SDE are sinonasal and otomastoid infections. Commonly affecting patients in the second and third decades, SDE could have a fulminant course with immediate complications and delayed morbidities including hydrocephalus, focal deficits, and epilepsy.
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Affiliation(s)
| | - Rahul Lohan
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
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38
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Manjila S, Singh G, Ndubuizu O, Jones Z, Hsu DP, Cohen AR. Endovascular plug for internal carotid artery occlusion in the management of a cavernous pseudoaneurysm with bifrontal subdural empyema: technical note. J Neurosurg Pediatr 2017. [PMID: 28621574 DOI: 10.3171/2017.3.peds16370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors demonstrate the use of an endovascular plug in securing a carotid artery pseudoaneurysm in an emergent setting requiring craniotomy for a concurrent subdural empyema. They describe the case of a 14-year-old boy with sinusitis and bifrontal subdural empyema who underwent transsphenoidal exploration at an outside hospital. An injury to the right cavernous segment of the ICA caused torrential epistaxis. Bleeding was successfully controlled by inflating a Foley balloon catheter within the sphenoid sinus, and the patient was transferred to the authors' institution. Emergent angiography showed a dissection of the right cavernous carotid artery, with a large pseudoaneurysm projecting into the sphenoid sinus at the site of arterial injury. The right internal carotid artery was obliterated using pushable coils distally and an endovascular plug proximally. The endovascular plug enabled the authors to successfully exclude the pseudoaneurysm from the circulation. The patient subsequently underwent an emergent bifrontal craniotomy for evacuation of a left frontotemporal subdural empyema and exenteration of both frontal sinuses. He made a complete neurological recovery. Endovascular large-vessel sacrifice, obviating the need for numerous coils and antiplatelet therapy, has a role in the setting of selected acute neurosurgical emergencies necessitating craniotomy. The endovascular plug is a useful adjunct in such circumstances as the device can be deployed rapidly, safely, and effectively.
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Affiliation(s)
- Sunil Manjila
- Division of Pediatric Neurosurgery, Rainbow Babies and Children's Hospital, Department of Neurological Surgery, The Neurological Institute, University Hospitals Case Medical Center
| | - Gagandeep Singh
- Division of Interventional Neuroradiology, Department of Radiology, University Hospitals Case Medical Center, Cleveland
| | - Obinna Ndubuizu
- Division of Pediatric Neurosurgery, Rainbow Babies and Children's Hospital, Department of Neurological Surgery, The Neurological Institute, University Hospitals Case Medical Center
| | - Zoe Jones
- Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
| | - Daniel P Hsu
- Kaiser Permanente Neuroscience Center, Redwood City, California; and
| | - Alan R Cohen
- Division of Pediatric Neurosurgery, Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland
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Yüksel MO, Gürbüz MS, Karaarslan N, Caliskan T. Rapidly progressing interhemispheric subdural empyema showing a three-fold increase in size within 12 hours: Case report. Surg Neurol Int 2016; 7:S872-S875. [PMID: 27999711 PMCID: PMC5154207 DOI: 10.4103/2152-7806.194495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 07/28/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Subdural empyema is a rare form of intracranial infection. It is described as accumulation of purulent infective material between the inner layer of dura mater and outer layer of arachnoid membrane. CASE DESCRIPTION A 17-year-old girl was admitted to the emergency department with acute left hemiplegia and was diagnosed with interhemispheric subdural empyema that showed a three-fold increase in size within 12 hours. Complete recovery was achieved with emergency surgical evacuation and additional 3 weeks of antibiotic treatment. CONCLUSION Subdural empyema should be diagnosed and managed early in time since it may progress very rapidly and can cause high morbidity and mortality. Complete recovery can be achieved if it is diagnosed early and treated in time.
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Affiliation(s)
- Mehmet O. Yüksel
- Department of Neurosurgery, Erzurum Bolge Training and Research Hospital, Erzurum, Turkey
| | | | - Numan Karaarslan
- Department of Neurosurgery, Namık Kemal University Faculty of Medicine, Tekirdag, Turkey
| | - Tezcan Caliskan
- Department of Neurosurgery, Namık Kemal University Faculty of Medicine, Tekirdag, Turkey
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40
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Piggott DA, Carroll KC, Lim M, Melia MT. Nontyphoidal Salmonellosis, Human Immunodeficiency Virus Infection, and Ischemic Stroke. Open Forum Infect Dis 2016; 3:ofw104. [PMID: 27419176 PMCID: PMC4943544 DOI: 10.1093/ofid/ofw104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/16/2016] [Indexed: 11/13/2022] Open
Abstract
Nontyphoidal Salmonella infection and stroke are major causes of morbidity and mortality worldwide, with increased risk in the human immunodeficiency virus (HIV)-infected population. We report a rare case of ischemic stroke associated with Salmonella enteritidis subdural empyema in an older HIV-infected patient with multimorbidity, despite surgery and treatment with susceptible antimicrobial drugs.
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Affiliation(s)
- Damani A Piggott
- Department of Medicine, Johns Hopkins University School of Medicine; Department of Epidemiology, Johns Hopkins University School of Public Health, Baltimore, Maryland
| | - Karen C Carroll
- Department of Medicine, Johns Hopkins University School of Medicine; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael T Melia
- Department of Medicine, Johns Hopkins University School of Medicine
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41
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Nguyen HS, Foy A, Havens P. Intracranial subdural empyema after surgery for lumbar lipomyelomeningocele: A rare complication. Surg Neurol Int 2016; 7:S301-4. [PMID: 27274400 PMCID: PMC4879841 DOI: 10.4103/2152-7806.182388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 03/07/2016] [Indexed: 12/03/2022] Open
Abstract
Background: Surgery is routinely recommended for lumbar lipomyelomeningocele, especially in the setting of tethered cord syndrome. The most common complications are wound infections and cerebrospinal fluid (CSF) leak, which remain confined to the surgical site. To the best of our knowledge, there have been no prior reports relating an intracranial subdural empyema following detethering surgery. Prompt diagnosis is essential since subdural empyema is a neurosurgical emergency. Case Description: The patient was an 11-month-old male who underwent detethering surgery for a lumbar lipomyelomeningocele. This was followed by wound drainage consistent with CSF leak, requiring revision. Cultures grew three aerobes (Escherichia coli, Enterococcus, and Klebsiella) and three anaerobes (Clostridium, Veillonella, and Bacteroides). He was started on cefepime, vancomycin, and flagyl. The patient required two more wound revisions and placement of an external ventricular drain (EVD) secondary to persistent wound leakage. A subsequent magnetic resonance imaging (MRI) brain was carried out due to protracted irritability, which revealed extensive left subdural empyema along the parietooccipital region and the inferior and anterior temporal lobe. He underwent evacuation of the subdural empyema where cultures exhibited no growth. Subsequently, he progressed well. His lumbar incision continued to heal. Serial MRI brains and inflammatory markers were reassuring. He weaned off his EVD and went home to complete a 6-week course of antibiotics. Upon completion of his antibiotics, he returned for a clinic visit; he exhibited no interim fevers or wound issues; cranial imaging documented no evidence of a residual or recurrent subdural empyema. Conclusion: Intracranial subdural empyema may occur after wound complications from detethering surgery despite early initiation of broad-spectrum antibiotics. Possible etiology may be local wound infection that seeds the subdural space and travels to the cranium, leading to meningitis and subdural empyema. Such a scenario should prompt surveillance imaging of the head as undiagnosed subdural empyema may lead to devastating consequences.
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Affiliation(s)
- Ha Son Nguyen
- Department of Neurosurgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Andrew Foy
- Department of Neurosurgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Peter Havens
- Department of Infectious Diseases, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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Stevens EM, Frendø M, von Buchwald C. Late diagnosis of odontogenic sinusitis with near-fatal outcome - a case report. Clin Case Rep 2016; 4:261-4. [PMID: 27014448 PMCID: PMC4771853 DOI: 10.1002/ccr3.485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 11/30/2015] [Accepted: 12/16/2015] [Indexed: 11/17/2022] Open
Abstract
Subdural empyema is a rare but potentially life‐threatening complication to sinusitis. Awareness of infection and early diagnosis is of the essence when dealing with a putatively immunosuppressed patient. Furthermore, patients at increased risk of infections due to immunosuppression need to be fully informed of risks associated with their treatment.
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Affiliation(s)
- Elizabeth M Stevens
- Department of Otolaryngology, Head and Neck Surgery and Audiology Rigshospitalet Copenhagen University Hospital Blegdamsvej 9 DK 2100 Copenhagen Denmark
| | - Martin Frendø
- Department of Otolaryngology, Head and Neck Surgery and Audiology Rigshospitalet Copenhagen University Hospital Blegdamsvej 9 DK 2100 Copenhagen Denmark
| | - Christian von Buchwald
- Department of Otolaryngology, Head and Neck Surgery and Audiology Rigshospitalet Copenhagen University Hospital Blegdamsvej 9 DK 2100 Copenhagen Denmark
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Solanki SP, Taylor C, Robertson I. Hereditary haemorrhagic telangiectasia manifesting as subdural empyema. Br J Neurosurg 2016; 30:356-8. [PMID: 26982736 DOI: 10.3109/02688697.2016.1155695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Hereditary haemorrhagic telangiectasia (HHT) also known as Osler-Weber-Rendu disease is a rare autosomal dominant condition causing vascular dysplasia. Cerebral abscess formation, secondary to paradoxical septic emboli via HHT-derived pulmonary arteriovenous malformations (pAVMs) in this context is well documented. Herein, we present the first case of subdural empyema with this aetiology.
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Affiliation(s)
- Sandeep P Solanki
- a Department of Neurosurgery , Queen's Medical Centre , Nottingham , UK
| | | | - Iain Robertson
- a Department of Neurosurgery , Queen's Medical Centre , Nottingham , UK
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Idowu OE, Majekodunmi AA. Relationship between demography, etiology, level of consciousness, and outcome of surgical intracranial suppurations of bacterial origin in a tropical tertiary center. Asian J Neurosurg 2016; 11:41-5. [PMID: 26889278 PMCID: PMC4732241 DOI: 10.4103/1793-5482.165798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction: Intracranial suppurations (ICS) of bacterial origin are associated with significant mortality and morbidity. This study aimed to review demography, etiology, level of consciousness, and outcome of surgical ICS in a tropical tertiary hospital. Materials and Methods: All patients admitted to the neurosurgical unit within the study period of 7 years that had a surgical intervention for their ICS were prospectively included in the study. In accordance with the unit protocol, all patients in whom there was clinical suspicion of ICS had a preoperative computed tomography scan and/or magnetic resonance imaging done. The following data among others were documented and recorded electronically: demography, clinical and radiological diagnosis, etiology of ICS, admission Glasgow Coma Scale (GCS) score, type of neurosurgical intervention, mode of anesthesia, and outcome. Results: Forty-nine patients were included in the study. There were 33 males with a male-to-female ratio of 2.1:1. All patients presented at least a week after the use of antibiotics. The most common type of ICS was cerebral abscess (33 patients, 67.3%). There was no statistical significant association between outcome and age group (P = 0.630), gender (P = 0.999), diagnosis (P = 0.464), etiology of ICS (P = 0.169), solitary or multiplicity of ICS (P = 0.485), or type of offending organism (P = 0.278). Conclusions: ICS usually follows otorhinological infections in our center. The surgical outcome is dependent on the admission GCS score.
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Affiliation(s)
- Olufemi Emmanuel Idowu
- Department of Surgery, Neurosurgery Division, Lagos State University College of Medicine and Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Adetinuwe Adesunlola Majekodunmi
- Department of Anaesthesia, Lagos State University College of Medicine and Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
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Nguyen HS, Doan N, Shabani S, Gelsomino M, Mueller W. Co-presentation of a subdural empyema and an infected ventriculoperitoneal shunt in an adult patient: A rare complication with review of literature. Surg Neurol Int 2015; 6:S455-8. [PMID: 26539321 PMCID: PMC4604643 DOI: 10.4103/2152-7806.166785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/26/2015] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The occurrence of a subdural empyema as a complication of a ventriculoperitoneal (VP) shunt infection is rare. Only three articles have been published on this topic. Moreover, the available literature only involves pediatric patients. CASE DESCRIPTION The authors present a 38-year-old male with a preexisting right frontal subdural hygroma that developed into a subdural empyema in the presence of an infected right occipital VP shunt. A brief literature review is provided, and the pathogenesis is discussed. CONCLUSION This is the first known report regarding an adult patient with a subdural empyema and a VP shunt infection. Although a magnetic resonance imaging (MRI) brain is not typically ordered during diagnosis of a shunt infection, the authors advocate a low threshold to employ MRI brain to evaluate for other sources of infection, especially in an immunocompromised patient or in a patient with a history of a subdural hematoma or hygroma that can be easily overlook as being stable on computed tomography of head.
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Affiliation(s)
- Ha Son Nguyen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ninh Doan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Saman Shabani
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Michael Gelsomino
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Wade Mueller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Munusamy T, Dinesh SK. Delayed Occurrence of Escherichia coli Subdural Empyema Following Head Injury in an Elderly Patient: A Case Report and Literature Review. J Neurol Surg Rep 2015; 76:e79-82. [PMID: 26251817 PMCID: PMC4521004 DOI: 10.1055/s-0035-1547366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 12/15/2014] [Indexed: 10/29/2022] Open
Abstract
Subdural empyema is a rare but serious intracranial infection that warrants prompt management to reduce morbidity and avoid mortality. However, clinical and radiologic features may be subtle or ambivalent. Thus a diagnosis of subdural empyema should not be discounted, especially in a patient with a history of head trauma. Treatment consists of surgery to establish bacteriologic identification and subsequently guide antibiotic therapy. Here we present a case of delayed Escherichia coli subdural empyema following a head injury in an elderly patient without significant risk factors. Computed tomography imaging was equivocal for subdural empyema. The patient underwent surgery and was treated with intravenous antibiotic therapy. Although initial improvement in the patient's clinical condition was observed, he eventually succumbed to nosocomial pneumonia. In this article, we discuss the presentation, diagnostic tools, and treatment options for subdural empyema with an emphasis on the challenges. The management conundrum that follows prompted us subsequently to review the literature.
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Abstract
The authors report the case of a 58-year-old man who presented with a cervicothoracolumbosacral spinal subdural abscess about a month after receiving an epidural steroid injection for management of low-back pain due to L5-S1 disc herniation. Although he presented with symptoms concerning for a spinal etiology, the subdural empyema was not evident on the initial MRI study and was observed on imaging 5 days later. This patient was successfully managed with surgical intervention and antibiotic treatment, and he is doing well more than 21 months after the operation. It is possible that a prior history of disc herniation or other spinal abnormality may increase a patient's risk of developing spinal subdural empyema. This case illustrates the risk of infection following spinal epidural steroid injections and the importance of early recognition and intervention to successfully treat an extensive subdural abscess.
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Kanu OO, Nnoli C, Olowoyeye O, Ojo O, Esezobor C, Adeyomoye A, Bankole O, Asoegwu C, Temiye E. Infantile subdural empyema: The role of brain sonography and percutaneous subdural tapping in a resource-challenged region. J Neurosci Rural Pract 2014; 5:355-9. [PMID: 25288836 PMCID: PMC4173231 DOI: 10.4103/0976-3147.139978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: This study explored the outcome of children with patent anterior fontanelles who were treated with trans-fontanelle ultrasound scan (TFUSS), which is more affordable and available than CT scan and MRI in the diagnosis of childhood intracranial pathologies and treatment of subdural empyema, in developing countries. Patients and Methods: Seventeen infants with post-meningitic subdural empyema, diagnosed using trans-fontanelle ultrasound alone and treated with subdural tapping over a 31-months period, were studied. Results: Eleven patients presented with grades II and III Bannister and William grading for level of consciousness in intracranial subdural empyema. Aspirate from 7 (41.2%) patients were sterile. The most common organisms isolated were Streptococcus faecalis 3 (17.6%), Haemophilus Influenza 2 (11.8) and Staphylococcus aureus 2 (11.8), multiple organisms were isolated in three of the patients. Ninety-four percent (94%) of the patients had good outcome. Five subjects developed hydrocephalus, one patient had a recurrence of subdural empyema, four patients had residual hemiparesis, two of the four patients had speech difficulties, while one patient (~6%) died. Conclusion: While CT and MRI remain the gold standard for investigating intracranial lesions, transfontanelle ultrasonography is adequate for diagnosis of infantile subdural empyema in resource-challenged areas. Percutaneous subdural tap is an affordable and effective therapy in such patients with financial challenges.
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Affiliation(s)
- Okezie Obasi Kanu
- Department of Surgery, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Chinenye Nnoli
- Department of Paediatrics, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Omodele Olowoyeye
- Department of Radiodiagnosis, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Omotayo Ojo
- Department of Surgery, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Christopher Esezobor
- Department of Paediatrics, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Adekunle Adeyomoye
- Department of Radiodiagnosis, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Olufemi Bankole
- Department of Surgery, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Chinyere Asoegwu
- Department of Surgery, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
| | - Edamisan Temiye
- Department of Paediatrics, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria
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Yıldırmak T, Gedik H, Simşek F, Kantürk A. Community-acquired intracranial suppurative infections: A 15-year report. Surg Neurol Int 2014; 5:142. [PMID: 25317357 PMCID: PMC4192928 DOI: 10.4103/2152-7806.141891] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/16/2014] [Indexed: 12/01/2022] Open
Abstract
Background: The aim of this study was to retrospectively evaluate the characteristics, treatment, and prognosis of patients with intracranial suppurative infection (ISI) by review of clinical, radiological, and laboratory findings. Methods: The data collected from all patients who had been diagnosed with ISI and followed up at the Infectious Diseases and Clinical Microbiology Department of the study site between 1998 and 2013 were reviewed. Results: Of the 23 ISI patients identified, the mean age was 38.21 ± 12.61 years (range: 19–67 years, median: 34) and mean symptom duration was 22.25 ± 20.22 days. Headache was the most common symptom, the frontal lobe the most common localization of ISI, and mastoiditis due to chronic suppurative otitis media the most common source of infection causing ISI. Proteus mirabilis, Pseudomonas spp., Peptostreptococcus spp., Enterococcus avium, Mycobacterium tuberculosis complex, and Toxoplasma gondii were isolated from the specimens collected from 6 (37.5%) of the 16 patients who underwent invasive procedures. Of these 16 patients, 2 underwent craniotomy, 12 burr hole aspiration, and 2 stereotactic biopsy. The rate of recurrence was 0% and the rates of sequelae and fatality were both 8%. Conclusions: ISI should be considered in male patients presenting with headache and neurological signs and symptoms, whether with or without fever, on admission for early diagnosis and provision of timely, adequate therapy and, if required, surgical intervention to reduce mortality and sequelae rates.
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Affiliation(s)
- Taner Yıldırmak
- Department of Infectious Diseases and Clinical Microbiology, MoH Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Habip Gedik
- Department of Infectious Diseases and Clinical Microbiology, MoH Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Funda Simşek
- Department of Infectious Diseases and Clinical Microbiology, MoH Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Arzu Kantürk
- Department of Infectious Diseases and Clinical Microbiology, MoH Okmeydanı Training and Research Hospital, İstanbul, Turkey
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Rasheed A, Khawchareonporn T, Muengtaweepongsa S, Suebnukarn S. An unusual presentation of subdural empyema caused by Porphyromonas gingivalis. Ann Indian Acad Neurol 2013; 16:723-5. [PMID: 24339621 PMCID: PMC3841642 DOI: 10.4103/0972-2327.120447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/23/2013] [Accepted: 07/29/2013] [Indexed: 11/04/2022] Open
Abstract
Subdural empyema is an uncommon clinical entity. The first case of Porphyromonas gingivalis subdural empyema is reported. We report a case of 34-year-old male who presented with subdural empyema and sinusitis. Through the utilization of polymerase chain reaction (PCR) tests on subdural pus, we were able to confirm the diagnosis and institute appropriate treatment. Early surgical intervention and intravenous antibiotics meant that the patient recovered fully. Infections caused by P. gingivalis should be considered in differential diagnoses of central nervous system (CNS) abscesses or subdural empyema especially in patients with precedent periodontal diseases and sinusitis.
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Affiliation(s)
- Ahmed Rasheed
- Department of Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
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