[Subdural empyema secondary to sinusitis: four pediatric cases].

INTRODUCTION

Perinasal sinus infections is a common and benign condition in most pediatric cases. Because of the widespread use of antibiotics, intracranial extension of sinusitis is rarely seen today. Nevertheless, the clinician must be aware of the gravity of this condition, because late recognition and delay in treatment can increase mortality and morbidity. The authors made a retrospective study of pediatric patients admitted to Garcia de Orta Hospital between 1996 and 2001 with the diagnosis of subdural empyema and sinusitis.

CASE REPORTS

Four patients were identified, with ages between 9 and 13 years. Prodromal manifestations of sinusitis were present in all, followed several days later by headaches, fever, vomiting and neurological abnormalities. Two patients presented in the emergency department with an acute confusional state and a non convulsive status epilepticus. The other two patients had a longer duration of disease, severe deterioration of consciousness and focal neurologic signs. Medical treatment was started in all cases at admission, but none improved significantly before being submitted to surgical intervention, which was repeated several times in two patients. Streptococcus milleri and anaerobic organisms were isolated. There was no mortality and global evolution was favorable, with a median follow up of 32 months.

CONCLUSIONS

Clinical presentation of subdural empyema can be relatively inespecific, requiring a high degree of suspicion. Facing a young adolescent with fever of unknown origin associated with any neurological abnormality and previous history of sinusitis, neuroradiological investigation shoul be asked. Early diagnosis and treatment are the mainstays of successful outcome.