11/124. Juxtapositioning of the temporalis muscle for intractable subdural empyema in infants. We present a case of refractory infantile subdural empyema secondary to pneumococcal meningitis. Initial treatment was with antibiotics and multiple burr hole drainage of the subdural space. As there was no significant improvement with this standard procedure, craniectomy, and juxtapositioning of the temporalis muscle was conducted and the patient recovered promptly. ( info) |
12/124. Treatment of intracranial abscess in the era of neuroimaging: an analysis of 13 consecutive cases. We report a series of 13 consecutive patients with intracranial abscess treated at our institution since examination by computed tomography (CT) became available. After various treatments, all abscesses healed. CT has broadened the range of treatment options. Manual puncture was performed in most patients. Stereotactic aspiration through a burr hole, medical therapy alone, or complete excision, including the capsule, via craniotomy may be chosen in cases selected by CT analysis. Individualization of treatment in this disease has become increasingly valuable in effecting a cure. ( info) |
| We describe a patient with meningitis and a subdural empyema arising from an infection after teeth extraction in which capnocytophaga species was detected. The patient was a 54-y-old man without any underlying diseases. A computerized tomography scan showed a subdural empyema 21 d after the extraction. ( info) |
14/124. Subdural empyemas--a rare complication of meningococcal cerebrospinal meningitis in children. Subdural empyemas are a rare, life-threatening complication of cerebrospinal meningitis. Two cases of subdural empyemas which occurred as early complications after cerebrospinal meningitis in infants are presented. Utilization of modern diagnostic methods, such as US and CT allowed to establish an early diagnosis, which made it possible to institute appropriate treatment, involving evacuation of the purulent content with local application of antibiotics followed by intravenous antibiotics well penetrating the fluid-filled compartments of the CNS. Early institution of treatment gave a chance of complete recovery in both presented cases. ( info) |
15/124. Rhinoorbitocerebral actinomycosis. PURPOSE: To report a case of actinomycotic orbital abscess with subdural empyema and pansinusitis, an unusual presentation of a rarely seen infection. methods: Case report. RESULTS: A 35-year-old man sought treatment for signs and symptoms of an orbital abscess 22 days after a dental extraction. Computed tomography demonstrated a left orbital abscess with left pansinusitis and a large subdural empyema. Surgical clearance of all purulent material was done followed by prolonged penicillin therapy. culture of pus from all sources yielded actinomycosis israelii. At the time of discharge and 1-month follow-up, the patient had 20/20 vision with no neurologic deficits. CONCLUSIONS: In orbital infections with atypical presentations, unusual pathogens should be considered as the causative agents. ( info) |
16/124. An unusual presentation of neurotuberculosis: subdural empyema. Case report. tuberculosis continues to be a major public health concern, especially in developing countries. Many types of neurotuberculosis have been described, but there is only one previously reported case of subdural empyema caused by tuberculous bacilli. A 1-year-old boy who had been treated for pulmonary tuberculosis was referred to the authors' institution with a diagnosis of right frontoparietal extraaxial abscess formation. Computerized tomography and magnetic resonance imaging revealed an extraaxial abscess with no evidence of calvarial infection. A craniotomy was performed to drain the pus, which was located subdurally. A polymerase chain reaction test yielded positive results, and histopathological examination revealed caseation. Antituberculous treatment was started after a diagnosis of subdural empyema with related neurotuberculosis had been made. At the end of a 12-month course of medical therapy, the patient was well with no evidence of tuberculosis. ( info) |
17/124. Pott's puffy tumour: still not an eradicated entity. Pott's puffy tumour is an infrequent entity characterised by one or more subperiosteal abscesses associated with frontal bone osteomyelitis. Although cases in patients of all ages have been reported, teenagers are the most frequently affected. early diagnosis and aggressive treatment are essential because of the high risk of severe neurological complications, such as epidural abscess, subdural empyema, and secondary septic thrombosis of the dural sinuses. This paper describes the case of a patient with a subperiosteal abscess resulting from sinusitis, with orbital and intracranial extension, and subsequent neurological complications. Despite modern methods of diagnosis and treatment, 13 new cases have been published in the last 5 years; in at least 3 (23%) of these cases there were serious neurological complications. Upper respiratory infections and sinusitis are leading causes of visits to the emergency department in the paediatric age group; however, no risk factors for poor outcome have so far been identified in any of these patients. ( info) |
18/124. Subdural empyema secondary to odontogenic masticator space abscess: detection by indium-111-labeled white cell scan. Subdural empyema (SDE) is an extremely rare but serious complication of dental infection. A case is presented in which dental infection was complicated by a masticator space abscess and eventually led to a SDE. This report illustrates a rare sequence of events leading to SDE and its serendipitous detection by indium-111-labeled leucocyte scan. ( info) |
19/124. Focal intracranial infections due to propionibacterium acnes: report of three cases. OBJECTIVE AND IMPORTANCE: Except for its role in shunt infections, propionibacterium acnes has been of little interest to neurosurgeons. The rarity and indolent nature of focal intracranial infections by P. acnes limit their recognition. Three cases of serious intracranial infection due to this organism are described. CLINCAL PRESENTATION: Three patients with histories of immunosuppression and neurosurgical procedures developed nonspecific, delayed presentations (5 wk to 5 yr after surgery) of intracranial infections. In two patients, radiological investigations showed enhancing lesions that were later found to be brain abscesses. A subdural empyema was found in the third patient. INTERVENTION: All three patients underwent surgical drainage of the purulent collections. P. acnes was isolated in each case, and each patient was treated with a 6-week course of intravenous penicillin. All three patients made good recoveries, and subsequent imaging showed no recurrence of the infectious collections. CONCLUSION: P. acnes is an indolent organism that may rarely cause severe intracranial infections. This organism should be suspected when an intracranial purulent collection is discovered in a patient with a history of neurosurgical procedures. Immunosuppressed patients may be susceptible to this otherwise benign organism. Surgical drainage and treatment with intravenous penicillin should be considered standard therapy. ( info) |
20/124. Interhemispheric subdural empyema--case report. We report a case of interhemispheric subdural empyema following a meningoencephalitis. Ten days after the beginning of his illness a CT scan showed a left interhemispheric subdural empyema with a low density collection, a faintly enhancing rim, multiple very small cortical abscesses and brain edema. The empyema was successfully treated by the direct introduction of a catheter into the left interhemispheric subdural space via a single posterior frontal parasagittal burr hole, irrigation with saline, aspiration of the empyema, and removal of the catheter at the end of operation. ( info) |