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Rare presentation of subdural empyema in a postnatal patient
  1. P Rastogi,
  2. U Rajesh,
  3. S Catling,
  4. S Davies,
  5. EH Kevelighan
  1. ABM University NHS Trust, Swansea, UK

Abstract

Subdural empyema is a rare condition with a quoted incidence of 0.2–1.2/10 000 hospital admissions.1 2 This has been reported in literature in association with otitis media and sinusitis.3 The authors report an unusual case of subdural empyema in the post natal period.

A 27-year-old primigravida who had an epidural and a ventouse delivery at term developed refractory headache. Despite a blood patch for suspected dural puncture, had continuous headache with facial numbness. Review by anaesthetic and medical on call teams excluded neurological deficits. A CT scan however confirmed a subdural collection involving the right frontal region, also extending to temporal region. Differential diagnosis included haemorrhage, Space occupying lesion as well as intracranial suppurative complications such as subdural empyema. There was no localised spinal tenderness or evidence of systemic infection. She underwent an emergency right craniotomy and evacuation of frontal and temporal subdural empeyema and a retro mastoid burr hole. She was commenced on intravenous imepenam postoperatively and made a slow recovery and follow up CT scans.

There is currently no reported case in literature of a subdural empeyema in the context of pregnancy. Lack of clinical, biochemical or microbiological evidence of an ascending spinal route of infection as a source of the rare condition in our patient made this unusual and posed diagnostic challenges. Early diagnosis, early and prompt neuro surgical intervention, drainage and aggressive antimicrobial therapy are mainstay of treatment of this rare condition in order to avoid significant morbidity and mortality.

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