Published online Nov 26, 2018. doi: 10.12998/wjcc.v6.i14.825
Peer-review started: August 5, 2018
First decision: August 31, 2018
Revised: September 21, 2018
Accepted: October 12, 2018
Article in press: October 11, 2018
Published online: November 26, 2018
Processing time: 114 Days and 1.6 Hours
A 64-year-old woman presented with a progressive headache, deteriorating consciousness, difficulty speaking, and weakness in the left extremities for 2 d.
Subdural empyema complicated with intracranial hemorrhage.
Chronic or subacute subdural hematoma.
While a culture of the operative empyema grew Corynebacterium, blood culture was negative.
A cranial CT showed a hypodense crescent-shaped accumulation of extra-axial fluid in addition to a local hyperdense lesion over the right hemisphere. There was a marked midline shift, and a tentorial herniation had formed.
A burr-hole craniostomy with continuous closed system drainage and use of antibiotics were administered to the patient.
A patient presenting with subdural empyema after completion of concurrent chemoradiotherapy for stage IVB nasopharyngeal carcinoma (NPC) has been reported in detail by Dr. Chan from Singapore National University Hospital in 2006.
Burr-hole craniotomy under CT or MRI guidance is an invasive surgical approach for chronic subdural hematoma or subdural empyema. Compared with craniotomy, burr-hole drainage can be performed under local anesthesia and is a less invasive surgical choice for patients with old age or poor health condition.
Subdural empyema is a rare but life-threatening complication in postradiotherapy NPC. It results from hematogenous seeding opportunistic pathogenic bacteria rather than sinusitis. Subdural empyema can mimic chronic or subacute subdural hematoma because of the similar clinical manifestations and imaging findings.