• Journal of Korean Neurosurgical Society
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• 제49권3호
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• pp.175-177
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• 2011

Subdural empyema is a rare form of intracranial sepsis associated with high morbidity and mortality. The most frequent cause is extension of paranasal sinusitis through emissary veins or of mastoiditis through the mucosa, bone, and dura mater. Development of subdural empyema after pyogenic meningitis is known to be very unusual in adults. We report a rare case of fatal subdural empyema, an unusual complication of pyogenic meningitis. Our bitter experience suggests that subdural empyema should be borne in mind in patient with pyogenic meningitis who exhibit neurological deterioration.

• Journal of Korean Neurosurgical Society
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• 제45권1호
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• pp.53-56
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• 2009

The authors present a case of subdural empyema in a macrocephalic patient. A 23-year-old male was admitted due to headache and fever. One month ago, he had mild head injury by his coworkers. Physical examination showed a macrocephaly and laboratory findings suggested purulent meningitis. Neuroimaging studies revealed a huge size of epidural space-occupying lesion. Under the impression of epidural abscess, operation was performed. Eventually, the lesion was located at subdural space and was proven to be subdural empyema. Later, histological examination of the specimen obtained by surgery demonstrated finings consistent with the capsule of the chronic subdural hematoma. Two weeks after operation, Propionibacterium acnes was isolated. The intravenous antibiotics were used for total of eight weeks under monitoring of the serum level of the C-reactive protein. Follow-up brain computed tomography (CT) scan showed the presence of significant amount of remaining subdural lesion. However, he has complained of minimal discomfort. It is suggested that the subdural empyema occurred with preexisting chronic subdural hematoma after head injury about one month prior to admission and it took a long time to treat Propionibacterium acnes subdural empyema with systemic antibiotics, at least over eight weeks.

• Journal of Korean Neurosurgical Society
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• 제47권6호
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• pp.470-472
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• 2010

Subdural empyema of the brain is an uncommon disorder that occurs more frequently in children than in adult. Authors report a very rare of subdural empyema following the subdural hygroma after mild head injury. The exact mechanism of infection is not known. However, we have to consider subdural infection as one of differential diagnosis in elderly patient with subdural hygroma when new abnormal density lesion is developed in the subdural space.

• Journal of Korean Neurosurgical Society
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• 제40권3호
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• pp.202-205
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• 2006

Osteomas of the paranasal sinuses rarely lead to intracranial manifestations. The authors report an unusual case of a frontal sinus osteoma leading to subdural emyema formation. A 19-year-old man presented with headache and fever one month after minor facial trauma. Neuroradiological studies revealed subdural empyema in left frontal lobe with moderate cerebral edema and a osteoma in the left frontal sinus with sinusitis of maxillary sinus. The patient was surgically treated in one stage operation of decompressive craniectomy, removal of subdural empyema with frontal sinus osteoma, and endoscopic sinus surgery via cranial and nasal route. The patient recovered very well after surgery and postoperative antibiotic therapy. The etiology of intracranial infection and the treatment strategy are to be discussed.

• Pediatric Infection and Vaccine
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• 제21권1호
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• pp.59-64
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• 2014

부비동염은 흔하고 일반적으로 소아에서는 양성질환인 경우가 많다. 경험적으로 사용하고 있는 항생제로 인해 소아의 부비동염의 두 개강 내 합병증은 드물지만, 발생할 경우 생명에 위협적일 수 있다. 두 개강 내 합병증은 정맥동 혈전, 안와 합병증, 뇌수막염, 뇌수막하 농양 등이 있다. 이러한 합병증은 소아에서 심각한 예후를 보일 수 있다. 따라서 뇌수막하 농양을 초기에 정확하게 진단하여 치료를 시작하는 것이 중요하다. 저자들은, 급성 부비동염 치료 중이던 15세 남아가 3일간의 발열, 두통을 동반한 편마비 증상으로 내원하여 뇌 전산화 단층촬영에서 뇌수막하 농양으로 진단되어 항생제 투여 및 신경학적 수술로 치료된 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제59권3호
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• pp.310-313
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• 2016

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.

• Journal of Korean Neurosurgical Society
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• 제45권6호
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• pp.397-400
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• 2009

This article presents the case of a bilateral chronic subdural hematoma which was contaminated with Klebsiella pneumoniae and resulted in a life-threatening central nervous system infection. After repeated of bilateral burr-hole drainage, the patient became hyperpyrexic and drowsy. Suppuration within the subdural space was suspected and then the patient underwent bilateral fronto-temporo-parietal craniotomies, and pus was evacuated. Its cultures revealed Klebsiella pneumoniae. Intravenous meropenem was given for 6 weeks. He recovered completely. Microorganisms like Klebsiella pneumoniae may directly infect the subdural space with iatrogenic contamination.

• Journal of Korean Neurosurgical Society
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• 제37권6호
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• pp.436-442
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• 2005

Objective: The detection rate of traumatic subdural hygroma(TSH) has increased after the development of computed tomography and magnetic resonance imaging. The treatment method and the mechanism of development of the TSH have been investigated, but they are still uncertain. This study is performed to evaluate the effectiveness of subduroperitoneal shunt in traumatic subdural hygroma. Methods: Five hundred thirty six patients were diagnosed as TSH from 1996 to 2002, among them, 55 patients were operated with subduroperitoneal shunt. We analyzed shunt effect on the basis of clinical indetails, including the patient's symptoms at the diagnosis, duration from diagnosis to operation, changes of GCS, hygroma types. We classified the TSH into five types (frontal, frontocoronal, coronal, parietal and cerebellar type) according to the location of the thickest portion of TSH. Results: The patients who have symptoms or signs related to frontal lobe compression (irritability, confusion) or increased intracranial pressure (headache, mental change), had symptomatic recovery rate above 80%. However, the patients who have focal neurological sign (hemiparesis, seizure and rigidity), showed recovery rate below 30%. The improvement rate was very low in the case of the slowly progressing TSH for over 6weeks. We experienced complications such as enlarged ventricle, chronic subdural hematoma, subdural empyema and acute SDH. Conclusion: Subduroperitoneal shunt appears to be effective in traumatic subdural hygroma when the patients who have symptoms or signs related to frontal lobe compression or increased ICP and progressing within 5weeks.

• Pediatric Infection and Vaccine
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• 제4권2호
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• pp.276-281
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• 1997

A 13-year-old male with normal immunity presented with Aspergillus brain abscess manifestating as frontal headache and fever. $T_2$-weight magnetic resonance imaging revealed a hypointense lesion in the right fronto-temporo-parietal lobe 1cm thickness and left midline shifting. The hypointense appearance on $T_2$-weighted images appears to be characteristic of aspergillosis. Right decompressive craniectomy and removal of subdural empyema right. Abscess culture was Aspergillus fumigatus. Antibiotic treatment with Amphotericin B was given for 2 months postoperatively. No recurrence was identified during 5 month follow-up.

• Journal of Korean Neurosurgical Society
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• 제41권6호
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• pp.371-376
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• 2007

Objective : The aim of this study was to investigate the usefulness of diffusion-weighted imaging [DWI] and apparent diffusion coefficiency [ADC] in distinguishing brain abscesses from cystic or necrotic brain tumors, which are difficult to be differentiated by conventional magnetic resonance imaging techniques. Methods : Seven patients with brain abscesses and ten patients with cystic brain tumors were studied from September 2003 to October 2005. Abscess, subdural empyema and ventriculitis were categorized to the abscess group and cystic or necrotic brain gliomas or metastatic brain tumors into the tumor group. Preoperative magnetic resonance images were performed in all patients and diffusion-weighted images and apparent diffusion coefficiency values of lesions were calculated directly from software of 1.5 tesla MRI [General Electrics, USA]. The ratio of the ADC of the lesion to contralateral regional ADC was also measured [relative ADC, rADC]. Results : The average ADC value of pyogenic abscesses group was $0.82+/-0.14{\times}10^{-3}\;[mean+/-S.D.]\;mm^2/s$ and mean rADC was 0.75. Cystic or necrotic areas had high ADC values [$2.49+/-0.79{\times}10^{-3}\;mm^2/s$, mean rADC=2.14]. ADC and rADC values of abscesses group showed about three times lower values than those of cystic or necrotic tumor group. Conclusion : This study results based on numerical comparison of signal intensities and quantitative analysis to distinguish between brain abscess and cystic or necrotic tumor, DWI and ADC mapping are thought to be very useful diagnostic tools.