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Non-contrast–enhancing subdural empyema: illustrative case
BACKGROUND: Subdural empyema (SDE) is a life-threatening intracranial infection that, without timely surgical intervention and appropriate antibiotic treatment, is inevitably fatal. SDE is classically recognized on brain imaging as a subdural collection surrounded by a contrast-enhancing ring. OBSER...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Association of Neurological Surgeons
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9706330/ https://www.ncbi.nlm.nih.gov/pubmed/36088564 http://dx.doi.org/10.3171/CASE22269 |
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author | Rebchuk, Alexander D. Chang, Stephano J. Griesdale, Donald E. G. Honey, Christopher R. |
author_facet | Rebchuk, Alexander D. Chang, Stephano J. Griesdale, Donald E. G. Honey, Christopher R. |
author_sort | Rebchuk, Alexander D. |
collection | PubMed |
description | BACKGROUND: Subdural empyema (SDE) is a life-threatening intracranial infection that, without timely surgical intervention and appropriate antibiotic treatment, is inevitably fatal. SDE is classically recognized on brain imaging as a subdural collection surrounded by a contrast-enhancing ring. OBSERVATIONS: The authors describe the case of a 41-year-old male with clinical features consistent with SDE but without any contrast enhancement on multiple computed tomography scans obtained more than 48 hours apart. Given the high clinical suspicion for SDE, a craniotomy was performed that demonstrated frank pus that eventually grew Streptococcus pyogenes. LESSONS: This case demonstrates that SDE may present without ring enhancement on contrast-enhanced imaging. In critically ill patients with a high clinical suspicion for SDE despite lack of contrast enhancement, we demonstrate that exploratory burr holes or craniotomy can provide diagnostic confirmation and source control. |
format | Online Article Text |
id | pubmed-9706330 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | American Association of Neurological Surgeons |
record_format | MEDLINE/PubMed |
spelling | pubmed-97063302022-11-30 Non-contrast–enhancing subdural empyema: illustrative case Rebchuk, Alexander D. Chang, Stephano J. Griesdale, Donald E. G. Honey, Christopher R. J Neurosurg Case Lessons Case Lesson BACKGROUND: Subdural empyema (SDE) is a life-threatening intracranial infection that, without timely surgical intervention and appropriate antibiotic treatment, is inevitably fatal. SDE is classically recognized on brain imaging as a subdural collection surrounded by a contrast-enhancing ring. OBSERVATIONS: The authors describe the case of a 41-year-old male with clinical features consistent with SDE but without any contrast enhancement on multiple computed tomography scans obtained more than 48 hours apart. Given the high clinical suspicion for SDE, a craniotomy was performed that demonstrated frank pus that eventually grew Streptococcus pyogenes. LESSONS: This case demonstrates that SDE may present without ring enhancement on contrast-enhanced imaging. In critically ill patients with a high clinical suspicion for SDE despite lack of contrast enhancement, we demonstrate that exploratory burr holes or craniotomy can provide diagnostic confirmation and source control. American Association of Neurological Surgeons 2022-08-08 /pmc/articles/PMC9706330/ /pubmed/36088564 http://dx.doi.org/10.3171/CASE22269 Text en © 2022 The authors https://creativecommons.org/licenses/by-nc-nd/4.0/CC BY-NC-ND 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ). |
spellingShingle | Case Lesson Rebchuk, Alexander D. Chang, Stephano J. Griesdale, Donald E. G. Honey, Christopher R. Non-contrast–enhancing subdural empyema: illustrative case |
title | Non-contrast–enhancing subdural empyema: illustrative case |
title_full | Non-contrast–enhancing subdural empyema: illustrative case |
title_fullStr | Non-contrast–enhancing subdural empyema: illustrative case |
title_full_unstemmed | Non-contrast–enhancing subdural empyema: illustrative case |
title_short | Non-contrast–enhancing subdural empyema: illustrative case |
title_sort | non-contrast–enhancing subdural empyema: illustrative case |
topic | Case Lesson |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9706330/ https://www.ncbi.nlm.nih.gov/pubmed/36088564 http://dx.doi.org/10.3171/CASE22269 |
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