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Complete recovery of interhemispheric subdural empyema extending to cerebellar tentorium treated with antibiotics as unimodal therapy: a case report and controversial literature review

  • Fadia Hasna Thohari ,
  • Paulus Sugianto ,
  • Djohan Ardiansyah ,

Abstract

Link of Video Abstract: https://youtu.be/ep7OSDbigho

Background:
Intracranial subdural empyema, although rare, represents an extreme medical and neurosurgical emergency. Multiple burr holes or a craniotomy for drainage and antibiotics are the treatment of choice. This case study aims to evaluate the complete recovery of interhemispheric subdural empyema extending to cerebellar tentorium treated with antibiotics as unimodal therapy.

Case Presentation: We present a case of a 40-year-old male with severe headache, a decrease of consciousness GCS E3V1M5, generalized onset tonic-clonic seizure, right abducens palsy, and right hemiparesis. Interhemispheric subdural empyema extending to cerebellar tentorium with associated intracranial abscess was seen from brain magnetic resonance imaging (MRI). Antibiotics were administered without surgical intervention due to the patient's family rejection. The patient regained full consciousness within 1 week and complete neurological function after 4 weeks of continuous use of antibiotics. The patient was discharged, and his recovery was uneventful on subsequent follow-up.

Conclusion: The use of antibiotics as monotherapy in subdural empyema is controversial, as it is widely accepted that surgery must be initiated as soon as possible in this pathology. It is indicated in small portions of cases without major neurological deficits or in particular conditions where surgery could not be performed. Still, more recent studies found it justifiable in patients with documented initial good responses. This case report highlights the complete recovery and the clinical outcome of antibiotics as monotherapy for subdural empyema.

References

  1. French H, Schaefer N, Keijzers G, Barison D, Olson S. Intracranial subdural empyema: A 10-year case series. Ochsner J. 2014;14(2):188–194.
  2. Mat Nayan SA, Mohd Haspani MS, Abd Latiff AZ, Abdullah JM, Abdullah S. Two surgical methods used in 90 patients with intracranial subdural empyema. J Clin Neurosci. 2009;16(12):1567–1571.
  3. Salunke PS, Malik V, Kovai P, Mukherjee KK. Falcotentorial subdural empyema: Analysis of 10 cases. Acta Neurochir (Wien). 2011;153(1):164–169.
  4. Bruner DI, Littlejohn L, Pritchard A. Subdural empyema presenting with seizure, confusion, and focal weakness. West J Emerg Med. 2012;13(6):509–511.
  5. Osborn MK, Steinberg JP. Subdural empyema and other suppurative complications of paranasal sinusitis. Lancet Infect Dis. 2007;7(1):62–67.
  6. Niklewski F, Petridis AK, Al Hourani J, Blaeser K, Ntoulias G, Bitter A, et al. Pediatric parafalcine empyemas. J Surg Case Reports. 2013;2013(8):rjt067–rjt067.
  7. Oleinikov B, Musa G, Livshitz MI, Kolcheva M, Ramirez M de JE, Nurmukhametov R, et al. Surgical Management of a Pediatric Infratentorial Subdural Empyema as a Complication of Parapharyngeal Abscess. Cureus. 2022;14(5):3–7.
  8. Mat Nayan SA, Abdullah MS, Naing NN, Mohd Haspani MS, Md Ralib AR. Correlations Between Subdural Empyema and Paraclinical As Well As Clinical Parameters Amongst Urban Malay Paediatric Patients. 2008;15(4):19–27.
  9. Pathak A, Sharma BS, Mathuriya SN, Khosla VK, Kak VK. Controversies in the Management of Subdural Empyema. Acta Neurochir (Wien). 1990;102(1):25–32.
  10. Greenlee JE. Subdural empyema. Curr Treat Options Neurol. 2003;5(1):13–22.
  11. De Bonis P, Anile C, Pompucci A, Labonia M, Lucantoni C, Mangiola A. Cranial and spinal subdural empyema. Br J Neurosurg. 2009;23(3):335–340.
  12. Adame N, Hedlund G, Byington CL. Sinogenic intracranial empyema in children. Pediatrics. 2005;116(3):e461-e467.
  13. Xue H, Zhang W, Shi L, Zhang Y, Yu B, Yang H. Subdural empyema complicated after trepanation and drainage of chronic subdural hematoma: A case report. Med (United States). 2019;98(52):1-4.
  14. Patel NA, Garber D, Hu S, Kamat A. Systematic review and case report: Intracranial complications of pediatric sinusitis. Int J Pediatr Otorhinolaryngol. 2016;86(1):200–212.
  15. Sung J, Kwon O, Kim D, Kim K. Bilateral subdural empyemas with meningitis secondary to acute barosinusitis. Eur Ann Otorhinolaryngol Head Neck Dis. 2018;135(6):457–459.
  16. Charlton A, Janjua N, Rejali D. Cotton bud in external ear canal causing necrotising otitis externa and subdural abscess. BMJ Case Rep. 2019;12(3):1–4.
  17. Otto WR, Paden WZ, Connors M, Joerger T, Buzi A, Rizzi M, et al. Suppurative Intracranial Complications of Pediatric Sinusitis: A Single-Center Experience. J Pediatric Infect Dis Soc. 2021;10(3):309–316.
  18. Germiller JA, Monin DL, Sparano AM, Tom LWC. Intracranial complications of sinusitis in children and adolescents and their outcomes. Arch Otolaryngol - Head Neck Surg. 2006;132(9):969–976.
  19. Waseem M, Khan S, Bomann S. Subdural Empyema Complicating Sinusitis. J Emerg Med. 2008;35(3):277–281.
  20. Quraishi H, Zevallos JP. Subdural empyema as a complication of sinusitis in the pediatric population. Int J Pediatr Otorhinolaryngol. 2006;70(9):1581–1586.
  21. Wu JF, Jin Z, Yang JM, Liu YH, Duan ML. Extracranial and intracranial complications of otitis media: 22-year clinical experience and analysis. Acta Otolaryngol. 2012;132(3):261–265.
  22. Yoon J, Redmond M. Check the ear. The importance of ear examinations in assessment of intracranial subdural empyema. Trop Med Infect Dis. 2019;4(3):1–8.
  23. Funakoshi Y, Hatano T, Ando M, Chihara H, Takita W, Tokunaga K, Hashikawa T, Kamata T, Higashi E, Nagata I. Intracranial Subdural Abscess Caused by Actinomyces meyeri Related to Dental Treatment: A Case Report. NMC Case Rep J. 2020;7(3):135–139.
  24. Hassine MBH, Oualha L, Derbel A, Douki N. Cerebral abscess potentially of odontogenic origin. Case Rep Dent. 2015;2015(1):4–7.
  25. Moazzam AA, Rajagopal SM, Sedghizadeh PP, Zada G, Habibian M. Intracranial bacterial infections of oral origin. J Clin Neurosci. 2015;22(5):800–806.
  26. Rasheed A, Khawchareonporn T, Muengtaweepongsa S, Suebnukarn S. An unusual presentation of subdural empyema caused by Porphyromonas gingivalis. Ann Indian Acad Neurol. 2013;16(4):723–725.
  27. Holland AA, Morriss M, Glasier PC, Stavinoha PL. Complicated subdural empyema in an adolescent. Arch Clin Neuropsychol. 2013;28(1):81–91.
  28. Rebchuk AD, Chang SJ, Griesdale DEG, Honey CR. Non-contrast–enhancing subdural empyema: illustrative case. J Neurosurg Case Lessons. 2022;4(6):2–4.
  29. Van Der Stel T, Treuniet FEE, Hoffmann C, Koppen H. Parafalcine empyema, a tricky infectious cause of headache: A case report. Am J Emerg Med. 2015;33(7):992.e1-992.e2.
  30. Yüksel M, Gürbüz M, Karaarslan N, Caliskan T. Rapidly progressing interhemispheric subdural empyema showing a three-fold increase in size within 12 hours: case report. Surg Neurol Int. 2016;7(38):S872–S875.
  31. Prieto R, Ortega C. Parafalcine subdural empyema: The unresolved controversy over the need for surgical treatment. Surg Neurol Int. 2019;10(203):1-8.
  32. Kazemi KA, Pishjoo M, Safdari Z. Interhemispheric Subdural Empyema in 16 Years Old Boy , A Case Report. Int J Med Investig. 2015;4(1):407–409.
  33. Arifianto MR, Ma’Ruf AZ, Ibrahim A, Bajamal AH. Interhemispheric and Infratentorial Subdural Empyema with Preseptal Cellulitis as Complications of Sinusitis: A Case Report. Pediatr Neurosurg. 2018;53(2):128–133.
  34. Agrawal A, Timothy J, Pandit L, Shetty L, Shetty JP. A review of subdural empyema and its management. Infect Dis Clin Pract. 2007;15(3):149–153.
  35. Alvis-Miranda H, Castellar-Leones S, Elzain M, Moscote-Salazar L. Brain abscess: Current management. J Neurosci Rural Pract. 2013;4(5):S67-S81.
  36. Bok APL, Peter JC. Subdural empyema: burr holes or craniotomy? J Neurosurg. 1993;78(4):574–578.
  37. Borovich B, Johnston E, Spagnuolo E. Infratentorial subdural empyema: Clinical and computerized tomography findings. Report of three cases. J Neurosurg. 1990;72(2):299–301.
  38. Nathoo N, Nadvi SS, Gouws E, Van Dellen JR. Craniotomy improves outcomes for cranial subdural empyemas: Computed tomography-era experience with 699 patients. Neurosurgery. 2001;49(4):872–878.
  39. Güçlü DG. Surgical management of interhemispheric subdural empyemas: review of the literature and report of 12 cases. Turkish J Trauma Emerg Surg. 2023;29(4):514–522.
  40. Mauser HW, Ravijst RAP, Elderson A, van Gijn J, Tulleken CA. Nonsurgical treatment of subdural empyema: Case report. J Neurosurg. 1985;63(1):128–130.
  41. Leys D, Destee A, Petit H, Warot P. Management of subdural intracranial empyemas should not always require surgery. J Neurol Neurosurg Psychiatry. 1986;49(6):635–639.
  42. Meshref M, Nourelden AZ, Elshanbary AA, AbdelQadir YH, Zaazouee MS, Ragab KM, et al. Subdural empyema due to mixed infections successfully treated medically: A case report with review literature. Clin Case Reports. 2022;10(7):1–11.
  43. Leys D, Christiaens JL, Derambure P, Hladky JP, Lesoin F, Rousseaux M, et al. Management of focal intracranial infections: Is medical treatment better than surgery? J Neurol Neurosurg Psychiatry. 1990;53(6):472–475.
  44. Van De Beek D, Campeau NG, Wijdicks EFM. The clinical challenge of recognizing infratentorial empyema. Neurology. 2007;69(5):477–481.
  45. Hockley AD, Williams B. Surgical Management of Subdural Empyema. Childs Brain. 1983;10(5):294–300.
  46. Feuerman T, Wackym PA, Gade GF, Dubrow T. Craniotomy improves outcome in subdural empyema. Surg Neurol. 1989;32(2):105–110.
  47. Gorgan M, Neacsu A, Bucur N, Pruna V, Lipan C, Sandu AM, et al. Brain abscesses: management and outcome analysis in a series of 84 patients during 12 year period. Rom Neurosurg. 2013;19(3):175–182.
  48. Jolayemi EO, Bankole OB, Ojo OA, Bamigboye B, Adebayo BO, Arekhandia BJ, et al. Contemporary Management of Intracranial Subdural Empyema: An Institutional Experience Abstract. J West African Coll Surg. 2022;12(3):56–63.
  49. Hendaus MA. Subdural empyema in children. Glob J Health Sci. 2013;5(6):54–59.
  50. Bernardini GL. Diagnosis and management of brain abscess and subdural empyema. Curr Neurol Neurosci Rep. 2004;4(6):448–456.
  51. Rasul FT, Chari A, Iqbal MO, Silva G, Hatcher J, Hartley J, et al. The case for early antibiotic commencement and source control in paediatric subdural empyema: A single-centre retrospective case series. Pediatr Neurosurg. 2022;57(1):28–34.
  52. Dharma BDA, Mulyantari NK, Prabawa IPY. Analisis korelasi kadar serum prokalsitonin dengan jumlah leukosit pada penderita dengan kecurigaan sepsis di RSUP Sanglah, Bali, Indonesia. Intisari Sains Medis. 2020;11(1):179-182.
  53. Maliawan S, Awyono S, Junus ES, Golden N. A Case Report Massive subdural empyema secondary to infectious parotitis: a case report. Bali Medical Journal. 2022;11(3):1884–1886.
  54. Risfandi M, Musyari S, Celia C. Acute subdural hemorrhage accompanied with rupture of the inferior vena cava: a case report. Bali Medical Journal. 2021;10(2): 507–509.
  55. Putra GH, Turchan A, Utomo SA, Parenrengi MA, Fauzi AA, Wibowo A. Causality relationship between Hounsfield Unit in epidural hematoma and subdural hematoma and hematoma expansion. Bali Medical Journal. 2023;12(2): 1502–1506.

How to Cite

Thohari, F. H., Sugianto, P., & Ardiansyah, D. (2023). Complete recovery of interhemispheric subdural empyema extending to cerebellar tentorium treated with antibiotics as unimodal therapy: a case report and controversial literature review. Bali Medical Journal, 12(2), 2307–2311. https://doi.org/10.15562/bmj.v12i2.4633

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Fadia Hasna Thohari
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Paulus Sugianto
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Djohan Ardiansyah
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