This case illustrates several of the complications associated with intracranial infection and that intracranial infection can occur in acute sinus infection.  This may even occur without direct intracranial extension from bony breach of the sinus.

This very ill patient has:

• bilateral subdural empyemas
• right MCA territory acute infarct
• partial thrombosis of the sagittal sinus thrombosis with a small left parietal cortical (likely venous) infarct
• acute pan-sinusitis

This is all in keeping with the sequelae of CNS infection, secondary to acute sinusitis.

The MRI nicely illustrates DWI imaging in three ways:

1. Acute cerebral infarction.
2. Subdural collections, indicating this is pus not a hygroma.
3. Pan-sinusitis with intense restriction suggesting pus.