Arifianto Muhammad Reza, Ma'ruf Achmad Zuhro, Ibrahim Arie, Bajamal Abdul Hafid
Department of Neurosurgery, Kanudjoso Djatiwibowo Hospital, Balikpapan, Indonesia.
Pediatr Neurosurg. 2018;53(2):128-133. doi: 10.1159/000481512. Epub 2017 Nov 11.
Intracranial complications of paranasal sinusitis have become rare due to the use of antibiotics nowadays. However, several cases have been reported due the ability of paranasal sinusitis to cause serious complications. Once the infection spreads over the cranial structure, it could infect the orbits, underlying bones, meninges, adjacent veins, and brain. Subdural empyema is a rare but potentially life-threatening complication following paranasal sinusitis and should be considered as a neurological emergency. The location where subdural empyema may appear is a challenge in diagnosis and treatment. We report the case of a 17-year-old boy who presented in a state of somnolence due to interhemispheric and infratentorial subdural empyema with preseptal cellulitis secondary to pansinusitis. Early diagnosis and aggressive antibiotic treatment combined with neurosurgical operation were mandatorily implemented. The case was managed using a multidisciplinary approach including the ENT, eye, and nutrition departments. The boy achieved clinical improvement, with impairment of eye movement as the only persistent symptom before discharge. Daily supervision at the primary health care center with continuous antibiotic treatment was recommended to the patient. Pertinent literature with controversies in the management of subdural empyema will be briefly discussed in this case report.
由于如今抗生素的使用，鼻窦炎的颅内并发症已变得罕见。然而，由于鼻窦炎有引发严重并发症的可能，已有数例相关病例被报道。一旦感染扩散至颅骨结构，它可能会感染眼眶、颅骨、脑膜、相邻静脉和大脑。硬膜下积脓是鼻窦炎后一种罕见但可能危及生命的并发症，应被视为一种神经科急症。硬膜下积脓可能出现的部位在诊断和治疗方面是一项挑战。我们报告了一例17岁男孩的病例，该男孩因全鼻窦炎继发眶隔前蜂窝织炎，出现大脑半球间和幕下硬膜下积脓，呈嗜睡状态。必须尽早进行诊断，并积极采用抗生素治疗并结合神经外科手术。该病例采用了包括耳鼻喉科、眼科和营养科在内的多学科方法进行治疗。该男孩病情得到临床改善，出院前仅遗留眼球运动障碍这一持续症状。建议患者在初级保健中心接受每日监测并持续进行抗生素治疗。本病例报告将简要讨论有关硬膜下积脓治疗争议的相关文献。
