[Clinical thinking and decision making in practice. A student with sudden headache].
A previously healthy man aged 18 years suddenly developed a severe headache, followed by nausea, vomiting, fever. During the following weeks a left-sided hemiparesis developed. CT of the brain revealed a pansinusitis and a frontal epidural empyema. A few days after surgical drainage his condition deteriorated and subsequent CT showed a right-sided subdural empyema. This was surgically evacuated and followed by long-term high-dose intravenous antibiotic therapy. The patient made a complete recovery. A sudden severe headache can be caused by an intracranial infection and intracranial pus collections can occur in the subdural as well as in the epidural space. Epidural empyema is a limited disease with relatively mild symptoms and a favourable prognosis, whereas subdural empyema may rapidly spread and cause severe disease with a poor prognosis. Quick antibiotic treatment and surgical drainage are required.
Saxena
R
R
Afd. Neurologie, Academisch Ziekenhuis Rotterdam-Dijkzigt. saxena@neur.azr.nl
Vandertop
W P
WP
Küppers
G L
GL
van Swieten
J C
JC
D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents; D019299:Decompression, Surgical; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D013354:Empyema, Subdural / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D020802:Epidural Abscess / Q000175:diagnosis; D006261:Headache / Q000382:microbiology*; D006801:Humans; D008297:Male; D010291:Paresis / Q000382:microbiology; D012852:Sinusitis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents