Empiema subdurale interemisferico in una ragazza di 15 anni

The Intracranial Complications of infection of the paranasal sinuses are uncommon and subdural empyema is rarer still. Roughly half of the cases of subdural empyema are caused by sinusitis and the most common source of infection is the frontal sinuses.

MR scan is the method of choice for the diagnosis and monitoring of subdural empyema, allowing prompt institution of appropriate treatment thereby reducing mortality.

We describe a 15-year-old girl with interhemispheric subdural empyema caused by fronto-ethmoidal sinusitis. Clinical onset was characterised by high fever, severe headache, nausea, vomiting and diplopia. CT scan showed evidence of a left parafalcial hypodense collection. MR scan, especially after contrast administration, showed the exact extension and location of the interhemispheric subdural empyema, also displaying the associated leptomeningitis and fronto-ethmoidal sinusitis. Prompt medical treatment led to a remission of symptoms and sinus infection with associated leptomeningitis as documented by serial MR monitoring. However, the slow progressive increase in size of the subdural collection was deemed an indication for neurosurgical management (evacuation of the collection by ventricular drainage catheters inserted under stereotaxic control) leading to a complete resolution of the subdural empyema without neurological sequelae.