Unusual intracranial suppuration: illustrative cases.

Anjali Pradhan,Paulin Munyemana,François Xavier Rutayisire,Claire Karekezi

doi:10.3171/case21570

Anjali Pradhan, Paulin Munyemana + Show 2 more

Open Access

https://doi.org/10.3171/case21570

Copy DOI

Abstract

BACKGROUNDIntracranial suppuration (ICS) is a rare complication that can arise from various disease processes and is composed of brain abscess, extradural empyema, and subdural empyema. Although significant progress has been achieved with antibiotics, neuroimaging, and neurosurgical technique, ICS remains a serious neurosurgical emergency. An uncommon presentation of ICS is sterile ICS, which has yet to be fully elucidated by clinicians. The authors present 2 cases of unusual sterile ICS: a sterile subdural empyema and a sterile brain abscess.OBSERVATIONSBoth patients underwent surgical treatment consisting of craniotomy to evacuate the pus collection. The blood cultures from both the patients, the collected empyema, and the thick capsule from the brain abscess were sterile. However, the necrotic brain tissue surrounding the abscess contained inflammatory cells. The authors’ review of the literature emphasizes the rarity of sterile ICS and substantiates the necessity for additional studies to explore this field.LESSONSSterile ICS is a disease entity that warrants further investigation to determine appropriate treatment to improve patient outcomes. This study highlights the paucity of data available regarding sterile ICS and supports the need for future studies to uncover the etiology of sterile ICS to better guide management of this condition.

Highlights

Intracranial suppuration (ICS) is a rare complication that can arise from various disease processes and is composed of brain abscess, extradural empyema, and subdural empyema
As reported in the literature, about 40–80% of patients with subdural empyema (SDE) have otorhinologic infections, most frequently of the paranasal sinuses, which leads to bacterial seeding of the subdural space.[21]
SDE typically presents with symptoms such as fever, headache, nausea, vomiting, focal neurological deficits, seizures, and meningeal irritation even when they are small in size.[8,29]

Summary

BACKGROUND

Intracranial suppuration (ICS) is a rare complication that can arise from various disease processes and is composed of brain abscess, extradural empyema, and subdural empyema. Neurological examination revealed right-sided hemiplegia and a Glasgow Coma Scale (GCS) score of 13 His blood laboratory test results, including neutrophil count, were within normal limits, and his initial C-reactive protein (CRP) was 5 mg/L. He was seen for follow-up 1 month after discharge in our outpatient clinic, and he had a complete neurological recovery His postoperative brain CT scan showed good resolution and evacuation of the empyema (Fig. 2). The patient was discharged from our institution after 5 weeks on oral antibiotics, including ciprofloxacin, cloxacillin, and metronidazole At his 1-month follow-up at our outpatient clinic, the patient made a complete neurological recovery apart from ongoing seizures A postoperative axial cut CT scan of the brain showed good evacuation of the left-sided occipital abscess (Fig. 4)

Discussion

Limitations

Findings

Conclusions