PMC5154207_01
(a) Contrast-enhanced cranial axial computed tomography (CT) scan immediately taken on admission reveals interhemisferic subdural empyema indicated with black arrows. (b) On cranial axial CT scan immediately taken on admission, black arrow indicates frontal sinusitis. (c) On cranial axial CT scan immediately taken on admission, black arrows indicate bilateral paranasal sinusitis. (d) Cranial T-1 weighted axial magnetic resonance imaging (MRI) scan taken on admission reveals interhemisferic subdural empyema indicated with black arrow. (e) Cranial T-1 weighted sagittal MRI scan taken on admission reveals interhemisferic subdural empyema indicated with black arrow. (f) Cranial T-2 weighted coronal MRI scan taken on admission reveals interhemisferic subdural empyema indicated with black arrow
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F1
C-reactive protein (7.8 mg/L), with 16 x 109/L white blood cells and 84% neutrophils. Cranial computed tomography (CT) and cranial magnetic resonance imaging (MRI) scans of the patient revealed interhemispheric subdural empyema and accompanying frontal and paranasal sinusitis [Figure 1a-f].
On cranial axial computed tomography scan taken following seizure, at the 12th hour of admission, reveals a 3-fold increase in the preexisting interhemisferic subdural empyema, indicated with black arrows
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F2
This cranial CT scan revealed interhemispheric subdural empyema with a three-fold increase in size within 12 hours compared to the CT taken on admission [Figure 2].
Postoperative cranial axial computed tomography scan reveals successful evacuation of interhemispheric subdural empyema. White arrow indicates the right parasagittal craniotomy defect
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F3
CT scan of the patient revealed that the empyema had been evacuated successfully [Figure 3]. Ceftriaxone (at a dose of 100 mg/kg/day), metronidazole (at a dose of 7.5 mg/kg every 6 hours), and vancomycin (at a dose of 15 mg/kg every 6 hours) were given empirically for 3 weeks.