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J Neurol Surg Rep 2015; 76(01): e79-e82
DOI: 10.1055/s-0035-1547366
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Delayed Occurrence of Escherichia coli Subdural Empyema Following Head Injury in an Elderly Patient: A Case Report and Literature Review

Thangaraj Munusamy
1   Department of Neurosurgery, National Neuroscience Institute, Singapore
,
Shree Kumar Dinesh
1   Department of Neurosurgery, National Neuroscience Institute, Singapore
› Author Affiliations
Further Information

Publication History

28 June 2014

15 December 2014

Publication Date:
23 March 2015 (online)

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Abstract

Subdural empyema is a rare but serious intracranial infection that warrants prompt management to reduce morbidity and avoid mortality. However, clinical and radiologic features may be subtle or ambivalent. Thus a diagnosis of subdural empyema should not be discounted, especially in a patient with a history of head trauma. Treatment consists of surgery to establish bacteriologic identification and subsequently guide antibiotic therapy. Here we present a case of delayed Escherichia coli subdural empyema following a head injury in an elderly patient without significant risk factors. Computed tomography imaging was equivocal for subdural empyema. The patient underwent surgery and was treated with intravenous antibiotic therapy. Although initial improvement in the patient's clinical condition was observed, he eventually succumbed to nosocomial pneumonia. In this article, we discuss the presentation, diagnostic tools, and treatment options for subdural empyema with an emphasis on the challenges. The management conundrum that follows prompted us subsequently to review the literature.

Keywords

subdural empyema - head injury - antibiotic therapy - chronic subdural hematoma
 

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