Sinogenic subdural empyema and Streptococcus anginosus.
Subdural empyema (SDE) is most commonly caused by sinusitis and, without early diagnosis and neurosurgical intervention, is associated with high mortality. In a patient with sinusitis who presents with mental status changes, the diagnosis of SDE should be suspected on clinical grounds, even in the absence of significant computed tomographic findings. Computed tomography with contrast is a useful aid in the diagnosis of SDE, but findings may be subtle, and contrasted magnetic resonance imaging is superior. The association of Streptococcus anginosus sinusitis and related intracranial sequelae is important owing to the potentially catastrophic complications and should be recognized by otolaryngologists. In view of the rapidly progressing nature of sinogenic SDE, physicians should strongly consider early institution of aggressive therapy consisting of craniotomy with concurrent sinus drainage in patients in whom sinogenic SDE is suspected on clinical grounds, particularly in the presence of S. anginosus-positive sinus cultures.
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Related Subject Headings
- Tomography, X-Ray Computed
- Streptococcus
- Streptococcal Infections
- Otorhinolaryngology
- Maxillary Sinusitis
- Male
- Magnetic Resonance Imaging
- Humans
- Fatal Outcome
- Ethmoid Sinusitis
Citation
Published In
DOI
ISSN
Publication Date
Volume
Issue
Start / End Page
Location
Related Subject Headings
- Tomography, X-Ray Computed
- Streptococcus
- Streptococcal Infections
- Otorhinolaryngology
- Maxillary Sinusitis
- Male
- Magnetic Resonance Imaging
- Humans
- Fatal Outcome
- Ethmoid Sinusitis