Authors
Ricardo G Blanco-Ortiz, Alejandro Arbona-Lampaya, Edwin J Medina González, Shermain Aponte Rosario, Alejandra Diaz-Rohena, Mayra Vizcarrondo
Published in
Cureus. Volume 18. Issue 9. Pages e115856. Epub Sep 06, 2026.
Abstract
Sinogenic subdural empyema is a rare and life-threatening complication of bacterial sinusitis. Non-specific symptoms tend to make early diagnosis and management challenging. We report the case of a previously healthy 16-year-old male who presented with a one-week history of upper respiratory symptoms and headache followed by a rapidly progressive neurologic deterioration. Multifocal subdural empyema was confirmed via multiparametric MRI. Cultures taken during neurosurgical intervention identified a polymicrobial etiology, including Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus constellatus,and Streptococcus intermedius, with the Streptococcus speciesbeing resistant to ceftriaxone and azithromycin. He underwent bifrontal craniotomies and endoscopic sinusotomies, followed by decompressive craniotomies for postoperative edema. In addition, he completed 59 days of culture-directed intravenous antimicrobial therapy. The patient recovered to his neurologic baseline. This case demonstrates the diagnostic pitfalls of early sinogenic subdural empyema in an adolescent, the role of multiparametric MRI over CT when there is suspected involvement of the intracranial space, and the potential for complete neurologic recovery despite a fulminant presentation requiring staged operative management.
PMID:
42840818
Bibliographic data and abstract were imported from PubMed on 07 Oct 2026.
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