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Abstract
Intracranial subdural empyema (ISE) is an uncommon condition previously associated with almost 100% morbidity and mortality. Since the introduction of antibiotics and advancements in diagnosis the complication rates have significantly improved. We report an unusual case of a 32-year-old Aboriginal male diagnosed with ISE. On closer inspection the ISE was found to be a complication of otitis media with a cotton bud lodged in the external acoustic meatus. The report provides a literature review on the relationships of ISE, otitis media and foreign bodies. We conclude that although rare, all patients with suspected ISE should undergo an ear examination as it is at no cost to the patient or health service but may be the difference between life and death.
Highlights
Before the advent of antibiotics, intracranial subdural empyema (ISE) had mortality reaching nearly 100% within 24–48 h from presentation [1,2,3,4,5,6,7]
We report a case of a 32-year-old Aboriginal male with left sided sub-temporal ISEs secondary to otitis media and externa
We review the literature of ISE, otitis media and highlight the importance of clinical suspicion and ear examination in patients presenting with features of ISE
Summary
Before the advent of antibiotics, intracranial subdural empyema (ISE) had mortality reaching nearly 100% within 24–48 h from presentation [1,2,3,4,5,6,7]. We found the presence of a foreign body resembling a cotton bud within the external acoustic meatus abutting the tympanic membrane To our knowledge this is the second reported case of ISE complicated by otitis media with a foreign body. EDluaryinign tshuisrgical intervention due to lack of clinical resources requiring more time for surgical planning During this time the patient deteriorated with re-emergence of fevers and early signs of haemodynamic instability. This prompted emergency sub-temporal craniotomy on day 4 of admission with the ENT. Dis. 2019, 4, 120 discussion between the infectious disease and neurosurgical team a consensus was reached for occipital craniotomy with re-opening of the previous sub-temporal craniotomy. At thceospaiomues taimmoeuwnthsiocfhpcuornufilernmt dediscShcaerdgoespwoerriuemdraapinioesdpefrrommumthegrnoewwtohcwciphiitcahl cwraansioptroemvyio, uansdlyscwoanbssidered posstiabkleenc. oDnutraaml binioapnsyt. wAafstedrontheeatsethceonsadmpertoimceedwuhreichthceonpfairtmieendt Smceaddoespaorimumarakpeiodspreercmouvmergyrowwitthh both normwa ahmlicavhriktweadal ssrpiegrcneovvsieoarunysdlwyiinctohflnabsmoidthmerneadotorpmroyasslmivbailterakcloesnrigstanomsfianCnaRdnPti.nA
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