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Empiema subdural secundario a sinusitis: Descripción de un caso pediátrico Subdural empyema secondary to sinusitis: A pediatric case report

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Author(s): A. Herrero | I. San Martín | L. Moreno | M. Herranz | J.C. García | E. Bernaola

Journal: Anales del Sistema Sanitario de Navarra
ISSN 1137-6627

Volume: 34;
Issue: 3;
Start page: 519;
Date: 2011;
Original page

Keywords: Empiema subdural | Infección bacteriana | Sistema nervioso central | Sinusitis | Subdural empyema | Bacterial infection | Central nervous system | Sinusitis

ABSTRACT
Presentamos el caso de un varón de 9 años derivado al servicio de Urgencias por proptosis ocular derecha y cefalea progresiva en el contexto de una sinusitis, diagnosticado dos días antes por clínica y radiología compatible y en tratamiento con amoxicilina-clavulánico. A la exploración física destaca proptosis derecha con ligera limitación para la mirada conjugada. Con la sospecha de una posible complicación neurológica de la sinusitis, se realiza tomografía axial computarizada (TAC) craneal, observando empiema subdural frontal derecho. Ingresa para tratamiento antibiótico endovenoso con cefotaxima, vancomicina y metronidazol. Es valorado por los servicios de Neurocirugía, Cirugía Maxilofacial y Otorrinolaringología (ORL) infantil, decidiéndose únicamente drenaje del foco primario, con actitud neuroquirúrgica expectante. El paciente evoluciona favorablemente con progresiva desaparición de los síntomas. Se realizan resonancias magnéticas periódicas, que muestran clara mejoría hasta resolución completa del empiema. Tras 4 semanas de antibioterapia iv., y tras la normalización clínica y radiológica, el paciente es dado de alta.We present the case of 9 year old male referred to the A and E service with right ocular proptosis and progressive migraine in the context of a sinusitis diagnosed two days earlier by compatible clinical and radiological tests, and receiving treatment with amoxicillin-clavulanic acid. Physcial exploration revealed right ocular proptosis with a slight limitation for conjugate gaze. Facing the suspicion of a possible neurological complication of the sinusitis, cranial computer aided tomography (CAT) was carried out, with right frontal subdural empyema observed. He was admitted for intravenous antibiotic treatment with cefotaxime, vancomicin and metronidazole. He was evaluated by child Neurosurgery, Maxillofacial Surgery and Otorhinolaryngology (ORL) services; the decision was taken to only drain the primary focus, while an expectant neurosurgical attitude was maintained. The patient evolved favourably with a progressive disappearance of the symptoms. Periodical magnetic resonances were carried out, which showed a clear improvement up until the complete resolution of the empyema. Following four weeks of antibiotherapy iv., and after clinical and radiological normalization, the patient was discharged.
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