Presentation
Arrived to the ED by ambulance - obtunded, no reaction to verbal or tactile stimulation, tonic-clonic seizure. Hypertonic - no reliable way of checking for nuchal rigidity. Suppuration from right ear; known recurrent otitis media in same ear.
Patient Data
Left frontal subarachnoid hemorrhage (SAH).
The arrows point to the subdural collections.
Case Discussion
A brain MRI (not shown) was promptly performed, verifying diffuse cerebral edema, bilateral subdural empyema, superior sagittal sinus (SSS) thrombosis, and left frontal subarachnoid hemorrhage (SAH).
The patient had been suffering from recurrent right otitis media, only this time it resulted in meningitis, plus the aforementioned complications. The dural venous sinus thrombosis was probably responsible for the SAH.
Blood cultures grew Streptococcus pyogenes.
Despite rigorous treatment, the patient passed away.
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