Presentation
Found unresponsive by parents in the morning. Patient had 6 days of fever, lethargy, and nausea/vomiting. Fixed and dilated pupil on physical exam.
Patient Data
There is a subdural hypodensity along the left hemispheric convexity. There are hypodensities within the anterior cranial fossa, left greater than right.
There is left hemispheric sulcal and left lateral ventricle effacement, with accompanying rightward midline shift.
Case Discussion
This is a subdural empyema.
The patient was brought to the operating room for emergent empyema evacuation, left craniectomy, and placement of a subdural drain. Intraoperative microbiologic specimens obtained were notable for 1+ Streptococcus anginosus and 4+ Fusobacterium. The patient had a peripherally inserted central catheter placed for long-term antibiotics.
Co-author:
Guy Gechtman
Travis Bevington, MD
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