Giant chronic calcified subdural empyema: a case report

Amal Saleh Nour,Kibruyisfaw Zewdie Shumbash

doi:10.1186/s13256-020-02429-2

Abstract

BackgroundChronic calcified subdural empyema is an exceedingly rare central nervous system infection with a handful of cases published to date. Reported cases presented with nonspecific clinical signs and symptoms. The duration between the initial onset of symptoms and diagnosis can vary drastically from a few years to up to 46 years. Although there are known predisposing causes, the initial source of infection can sometimes be difficult to identify.Case presentationOur patient was a 39-year-old Ethiopian man who presented with left-side body weakness of 6 years’ duration with worsening of symptoms of 6 months’ duration. He had no history of trauma, meningitis, or previous surgery. The results of routine laboratory tests were normal. The diagnosis was made by computed tomography and magnetic resonance imaging and was confirmed by surgery. Frontoparietal craniotomy was performed, and evacuation of non-foul-smelling collection was done. The patient was reoperated for tension pneumocephalus 48 hours after the initial surgery. He died 10 days later.ConclusionThis is a rare case of a giant chronic calcified subdural empyema with no known preceding history of trauma or infection.

Highlights

Intracranial subdural empyema is an infection that is contained within the space between the dura and arachnoid mater [1]
Reviewed reports have stated that cases of partially calcified empyema have become symptomatic 13 years after the initial onset of infection [4]
We present a case of a patient with a giant chronic calcified subdural empyema presenting 6 years after the initial symptoms

Summary

Introduction

Intracranial subdural empyema is an infection that is contained within the space between the dura and arachnoid mater [1]. Case presentation Our patient was a 39-year-old Ethiopian man who presented with left-side body weakness of 6 years’ duration He was admitted to our hospital with worsening of symptoms of 6 months’ duration with failure to communicate of 1 week and frequent falling episodes while attempting to walk. Nour and Shumbash Journal of Medical Case Reports (2020) 14:95 headache, abnormal body movement, and left-side facial deviation, as well as choking episodes He complained of occasional urinary incontinence; otherwise, he had no history of trauma, ear discharge, past history of sinusitis, or meningitis treatment. Brain MRI showed left frontoparietal convexity subdural collection that had mixed iso- and hypointense on axial T2-weighted images and slightly hyperintense signal on axial T1-weighted images with mass effect on the ipsilateral lateral ventricle (Fig. 2a and b).

Findings

Discussion

Conclusion