Epidural abscess complicating frontal sinusitis

Case contributed by Dr Derek Smith

Presentation

Presented with new generalised seizure. Recent period of generally unwell / URTI symptoms.

Patient Data

Age: 17
Gender: Male

Right frontal peripherally enhancing extradural collection with air, in continuation with frontal sinus opacifcation. The left anterior paranasal and maxillary sinuses are also opacified.

No other intracranial abnormality. No venous sinus thrombosis.

 

Patient reviewed by ENT and neurosurgery. Given ongoing discharge it was felt surgical drainage would add little benefit and the patient was managed conservatively with broad spectrum antibiotics and antiepileptic medication.

MRI

Two week interval MRI

Stable appearance of right frontal extradural abscess. Local dural thickening and enhancement. Restricted diffusion within this lesion. Resolution of intracranial gas. Focally increased T2w / FLAIR signal in the right frontal parenchyma, which may be reactive edema or developing cerebritis. No new collections or areas of signal abnormality.

Case Discussion

Given good clinical response and stable imaging, the patient was successfully managed conservatively. A three month follow up MRI (not included) showed resolution of the empyema and parenchymal signal change.

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Case information

rID: 64441
Published: 22nd Nov 2018
Last edited: 25th Nov 2018
Inclusion in quiz mode: Included

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