Subdural Empyema

Abstract

A 14yr old male presented with subdural empyema following a right frontal subaponeurotic abscess. Presented with a Glasgow coma scale of 8/15, left sided hemiplegia and a history of convulsions for 4 days. Other history was unremarkable. CT brain showed diffuse subdural empyema. There was no neurosurgeon on site and the patient declined referral to the nearest centre with neurosurgical services. Hence he was managed on IV chloramphenicol and metronidazole for 4weeks with clinical improvement evidenced by a Glasgow coma scale of 15/15, absence of seizures and an increase in power on the left side to 4/5. A repeat CT brain at 4weeks showed localised right parietal and occipital parafalcine empyema with cerebral oedema. Two craniotomies were done to drain the pus. He was then continued on cefotaxime, metronidazole for 3 more weeks, mannitol and dexamethasone for one week. Primary duraplasty was not done as the patient deteriorated in theatre due to anaesthetist complication. Klebsiella species was cultured sensitive to cefotaxime, chloramphenicol and ciprofloxacin. Repeat CT scan showed no residue empyema on day 7 post operation. Secondary duraplasty was done on day11 post craniotomy due to cerebrospinal fluid leakage. On day11 he was treated for malaria. The patient recovered well, neurologically intact, without any complications and no cerebrospinal fluid leak. He was discharged on day 10 post duraplasty on oral antibiotics for 4weeks after which cranioplasty was done.