title: The pediatric headache that would not go away.
abstract: We describe the clinical presentation, radiographic findings, management, and outcome of a subdural empyema in a 14-year-old male with history of recent partially treated acute sinusitis. Subdural empyema is a rare but life threatening complication, usually following paranasal sinusitis, otitis media, mastoiditis, cranial surgery, a skull fracture, or from distant spread from sites such as a pulmonary infection. The initial evaluation should include a thorough history and physical examination, complete blood count, electrolytes, C-reactive protein, erythrocyte sedimentation rate, chest x-ray, urinalysis, and neuroimaging of the brain with intravenous contrast. If a subdural empyema is identified, then intravenous antibiotics should be initiated, and immediate neurosurgical consultation should be obtained to consider operative drainage.
authors.affiliation: From the Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
authors.forename: Bryan
authors.initials: B
authors.lastname: Dunn
authors.forename: Chad
authors.initials: C
authors.lastname: McCalla
authors.forename: Brian
authors.initials: B
authors.lastname: Hiestand
authors.forename: Mary Claire
authors.initials: MC
authors.lastname: O'Brien
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy; D003244:Consciousness Disorders / Q000209:etiology; D003951:Diagnostic Errors; D004636:Emergency Service, Hospital; D013354:Empyema, Subdural / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D005334:Fever / Q000209:etiology; D015522:Frontal Sinusitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D006261:Headache / Q000209:etiology*; D006408:Hematoma, Subdural / Q000175:diagnosis; D006801:Humans; D008297:Male; D008881:Migraine Disorders / Q000175:diagnosis; D010462:Peptostreptococcus / Q000302:isolation & purification*; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents