Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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Posttraumatic Intracranial Tuberculous Subdural Empyema in a Patient with Skull Fracture

  • Kim, Jiha (Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University School of Medicine) ;
  • Kim, Choonghyo (Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University School of Medicine) ;
  • Ryu, Young-Joon (Department of Pathology, Kangwon National University Hospital, Kangwon National University School of Medicine) ;
  • Lee, Seung Jin (Department of Neurosurgery, Kangwon National University Hospital, Kangwon National University School of Medicine)
  • Received : 2014.12.23
  • Accepted : 2015.04.17
  • Published : 2016.05.01
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Abstract

Intracranial tuberculous subdural empyema (ITSE) is extremely rare. To our knowledge, only four cases of microbiologically confirmed ITSE have been reported in the English literature to date. Most cases have arisen in patients with pulmonary tuberculosis regardless of trauma. A 46-year-old man presented to the emergency department after a fall. On arrival, he complained of pain in his head, face, chest and left arm. He was alert and oriented. An initial neurological examination was normal. Radiologic evaluation revealed multiple fractures of his skull, ribs, left scapula and radius. Though he had suffered extensive skull fractures of his cranium, maxilla, zygoma and orbital wall, the sustained cerebral contusion and hemorrhage were mild. Eighteen days later, he suddenly experienced a general tonic-clonic seizure. Radiologic evaluation revealed a subdural empyema in the left occipital area that was not present on admission. We performed a craniotomy, and the empyema was completely removed. Microbiological examination identified Mycobacterium tuberculosis (M.tuberculosis). After eighteen months of anti-tuberculous treatment, the empyema disappeared completely. This case demonstrates that tuberculosis can induce empyema in patients with skull fractures. Thus, we recommend that M. tuberculosis should be considered as the probable pathogen in cases with posttraumatic empyema.

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References

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