A case report of frontal spontaneous epidural hematoma associated with cranial osteomyelitis and epidural abscess due to paranasal sinusitis

BACKGROUND: Intracranial epidural hematoma (EDH) is frequently secondary to trauma, but in some rare cases, spontaneous EDH (SEDH) could develop without trauma. Cranial osteomyelitis is an uncommon osseous infection that most frequently presents as a postoperative complication but also rarely originates from paranasal sinusitis and can develop extracranially to form a subperiosteal abscess or intracranially to form an epidural, subdural, or cerebral abscess. Intracranial epidural abscess (EDA) is an uncommon infection that forms in the space between the cranial bone and dura mater. It is rare to have a case of SEDH associated with cranial osteomyelitis and EDA due to paranasal sinusitis. CASE DESCRIPTION: An 18-year-old male was admitted to the hospital with headache, nausea, and vomiting for 2 days. The patient denied a history of head trauma, operation, and any other infectious and systemic diseases, and he was not taking any medication. CT scan demonstrated a mixed density lenticular mass with some air collection in the frontal region. The axial sinus CT image demonstrated opacification of the left frontal, ethmoid, and maxillary sinuses. An emergency operation confirmed the diagnosis of frontal SEDH associated with EDA and frontal osteomyelitis. The frontal EDH, abscess, and the infected bone were completely removed during the operation without opening the dura. The patient recovered well after receiving 8 weeks of antibiotic therapy, and a cranioplasty was performed 9 months after the craniectomy. CONCLUSION: To the best of our knowledge, SEDH associated with EDA is very rare. It is important to recognize the possibility of SEDH associated with cranial osteomyelitis and EDA due to paranasal sinusitis, and the presence of an EDA should, therefore, be considered in the differential diagnosis of cases of SEDH.