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Patel N, Rock M, Dowlati E, Phan T, Sanchez CE, Myseros JS, Oluigbo C, Syed HR, Donoho DA, Keating RF. Socioeconomic Disparities Affecting the Presentation and Outcomes in Pediatric Subdural Empyema Patients. Neurosurgery 2024; 94:764-770. [PMID: 37878410 DOI: 10.1227/neu.0000000000002741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 06/12/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric subdural empyemas (SDE) carry significant morbidity and mortality, and prompt diagnosis and treatment are essential to ensure optimal outcomes. Nonclinical factors affect presentation, time to diagnosis, and outcomes in several neurosurgical conditions and are potential causes of delay in presentation and treatment for patients with SDE. To evaluate whether socioeconomic status, race, and insurance status affect presentation, time to diagnosis, and outcomes for children with subdural empyema. METHODS We conducted a retrospective cohort study with patients diagnosed with SDE between 2005 and 2020 at our institution. Information regarding demographics (age, sex, zip code, insurance status, race/ethnicity) and presentation (symptoms, number of prior visits, duration of symptoms) was collected. Outcome measures included mortality, postoperative complications, length of stay, and discharge disposition. RESULTS 42 patients were diagnosed with SDE with a mean age of 9.5 years. Most (85.7%) (n = 36) were male ( P = .0004), and a majority, 28/42 (66.7%), were African American ( P < .0001). There was no significant difference in socioeconomic status based on zip codes, although a significantly higher number of patients were on public insurance ( P = .015). African American patients had a significantly longer duration of symptoms than their Caucasian counterparts (8.4 days vs 1.8 days P = .0316). In total, 41/42 underwent surgery for the SDE, most within 24 hours of initial neurosurgical evaluation. There were no significant differences in the average length of stay. The average length of antibiotic duration was 57.2 days and was similar for all patients. There were no significant differences in discharge disposition based on any of the factors identified with most of the patients (52.4%) being discharged to home. There was 1 mortality (2.4%). CONCLUSION Although there were no differences in outcomes based on nonclinical factors, African American men on public insurance bear a disproportionately high burden of SDE. Further investigation into the causes of this is warranted.
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Affiliation(s)
- Nirali Patel
- Department of Neurosurgery, Children's National Hospital, Washington , District of Columbia , USA
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Massimi L, Cinalli G, Frassanito P, Arcangeli V, Auer C, Baro V, Bartoli A, Bianchi F, Dietvorst S, Di Rocco F, Gallo P, Giordano F, Hinojosa J, Iglesias S, Jecko V, Kahilogullari G, Knerlich-Lukoschus F, Laera R, Locatelli D, Luglietto D, Luzi M, Messing-Jünger M, Mura R, Ragazzi P, Riffaud L, Roth J, Sagarribay A, Pinheiro MS, Spazzapan P, Spennato P, Syrmos N, Talamonti G, Valentini L, Van Veelen ML, Zucchelli M, Tamburrini G. Intracranial complications of sinogenic and otogenic infections in children: an ESPN survey on their occurrence in the pre-COVID and post-COVID era. Childs Nerv Syst 2024; 40:1221-1237. [PMID: 38456922 DOI: 10.1007/s00381-024-06332-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND COVID-19 pandemic is thought to have changed the epidemiology of some pediatric neurosurgical disease: among them are the intracranial complications of sinusitis and otitis (ICSO). According to some studies on a limited number of cases, both streptococci-related sinusitis and ICSO would have increased immediately after the pandemic, although the reason is not clear yet (seasonal changes versus pandemic-related effects). The goal of the present survey of the European Society for Pediatric Neurosurgery (ESPN) was to collect a large number of cases from different European countries encompassing the pre-COVID (2017-2019), COVID (2020-2021), and post-COVID period (2022-June 2023) looking for possible epidemiological and/or clinical changes. MATERIAL AND METHODS An English language questionnaire was sent to ESPN members about year of the event, patient's age and gender, presence of immune-deficit or other favoring risk factors, COVID infection, signs and symptoms at onset, site of primary infection, type of intracranial complication, identified germ, type and number of surgical operations, type and duration of medical treatment, clinical and radiological outcome, duration of the follow-up. RESULTS Two hundred fifty-four cases were collected by 30 centers coming from 14 different European countries. There was a statistically significant difference between the post-COVID period (129 children, 86 cases/year, 50.7% of the whole series) and the COVID (40 children, 20 cases/year, 15.7%) or the pre-COVID period (85 children, 28.3 cases/year, 33.5%). Other significant differences concerned the presence of predisposing factors/concurrent diseases (higher in the pre-COVID period) and previous COVID infection (higher in the post-COVID period). No relevant differences occurred as far as demographic, microbiological, clinical, radiological, outcome, morbidity, and mortality data were concerned. Paranasal sinuses and middle ear/mastoid were the most involved primary site of infection (71% and 27%, respectively), while extradural or subdural empyema and brain abscess were the most common ICSO (73% and 17%, respectively). Surgery was required in 95% of cases (neurosurgical and ENT procedure in 71% and 62% of cases, respectively) while antibiotics in 99% of cases. After a 12.4-month follow-up, a full clinical and radiological recovery was obtained in 85% and 84% of cases, respectively. The mortality rate was 2.7%. CONCLUSIONS These results suggest that the occurrence of ICSO was significantly increased after the pandemic. Such an increase seems to be related to the indirect effects of the pandemic (e.g., immunity debt) rather than to a direct effect of COVID infection or to seasonal fluctuations. ICSO remain challenging diseases but the pandemic did not affect the management strategies nor their prognosis. The epidemiological change of sinusitis/otitis and ICSO should alert about the appropriate follow-up of children with sinusitis/otitis.
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Affiliation(s)
- L Massimi
- Pediatric Neurosurgery, Neuroscience-Sense Organs-Chest Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Catholic University Medical School, Rome, Italy
| | - G Cinalli
- Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - P Frassanito
- Pediatric Neurosurgery, Neuroscience-Sense Organs-Chest Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - V Arcangeli
- Clinical Psychology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Auer
- Department of Neurosurgery, Johannes Kepler University Linz, Kepler University Hospital GmbH, Linz, Austria
| | - V Baro
- Pediatric and Functional Neurosurgery, Department of Neurosciences, University of Padova, Padua, Italy
| | - A Bartoli
- Department of Neurosurgery, Geneva University Hospitals, Geneva, Switzerland
| | - F Bianchi
- Pediatric Neurosurgery, Neuroscience-Sense Organs-Chest Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S Dietvorst
- University Hospitals Leuven, Leuven, Belgium
| | - F Di Rocco
- Hôpital Femme-Mère-Enfant, Université de Lyon, Lyon, France
| | - P Gallo
- Birmingham Children's Hospital, Birmingham, UK
| | - F Giordano
- University of Florence, Florence, Italy
- Meyer Children's Hospital IRCCS, Florence, Italy
| | - J Hinojosa
- Hospital Sant Joan de Déu, Barcelona, Spain
| | - S Iglesias
- Hospital Regional Universitario de Malaga, Malaga, Spain
| | - V Jecko
- Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - G Kahilogullari
- Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - F Knerlich-Lukoschus
- Division Pediatric Neurosurgery, Department of Neurosurgery, University Medical Center Göttingen, Göttingen, Germany
| | - R Laera
- Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - D Locatelli
- Neurosurgery Department, Università Dell'Insubria, Ospedale di Circolo e Macchi Foundation, Varese, Italy
| | - D Luglietto
- Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - M Luzi
- Azienda Ospedaliero Universitaria Delle Marche, Ancona, Italy
| | | | - R Mura
- Meyer Children's Hospital IRCCS, Florence, Italy
| | - P Ragazzi
- Department of Pediatric Neurosurgery, Ospedale Infantile Regina Margherita, Città della Salute e della Scienza, Turin, Italy
| | - L Riffaud
- Rennes University Hospital, Rennes, France
| | - J Roth
- Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Tel Aviv, Israel
| | - A Sagarribay
- Hospital Dona Estefânia-Centro Hospitalar Universitário, Lisboa, Portugal
- Hospital CUF Descobertas, Lisboa, Portugal
| | - M Santos Pinheiro
- Centro Hospitalar Lisboa Norte-Hospital Santa Maria, Lisboa, Portugal
| | - P Spazzapan
- University Medical Center-Ljubljana, Ljubljana, Slovenia
| | - P Spennato
- Santobono-Pausilipon Children's Hospital, AORN, Naples, Italy
| | - N Syrmos
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - L Valentini
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - M L Van Veelen
- Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands
| | - M Zucchelli
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Istituto Scienze Neurologiche Di Bologna, Boulogne, Italy
| | - G Tamburrini
- Pediatric Neurosurgery, Neuroscience-Sense Organs-Chest Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Neuroscience, Catholic University Medical School, Rome, Italy
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Raineau M, Crowe AM, Beccaria K, Luscan R, Simon F, Roux CJ, Ferroni A, Kossorotoff M, Harroche A, Castelle M, Gatbois E, Bourgeois M, Roy M, Blanot S. Pediatric intracranial empyema complicating otogenic and sinogenic infection. Int J Pediatr Otorhinolaryngol 2024; 177:111860. [PMID: 38224655 DOI: 10.1016/j.ijporl.2024.111860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 01/17/2024]
Abstract
OBJECTIVE To describe and compare clinical and microbiological features, surgical and medical management, and outcomes of children with otogenic and sinogenic intracranial empyema (IE) in an institution with an established multidisciplinary protocol. To use the study findings to inform and update the institutional algorithm. METHODS Retrospective analysis was carried out on the electronic healthcare records of all children with oto-sinogenic IE admitted in a 5-year period. RESULTS A total of 76 patients were identified and treated according to an institutional protocol. Two distinct groups were identified: intracranial empyema related to otogenic infection (OI-IE, n = 36) or sinogenic infection (SI-IE, n = 40). SI-IE was seen in older children and had a significantly higher morbidity. Sub-dural IE was seen in a minority (n = 16) and only in SI-IE and required urgent collaborative ENT-neurosurgery. Extra-dural IE occurred more frequently and was seen in both SI-IE and OI-IE. No death and overall low morbidity were observed. Particularities found in SI-IE and OI-IE groups (as thrombosis, microbiology, antibiotic treatment, duration and outcome) permitted the delineation of these groups in our updated algorithm. CONCLUSION The presence of a collaborative multidisciplinary protocol permits the step-wise co-ordination of care for these complex patients in our institution. All patients received prompt imaging, urgent surgical intervention, and antibiotic treatment. Microbiological identification was possible for each patient and antibiotic rationalization was permitted through use of Polymerase chain reaction (PCR) testing in cases of sterile cultures. Of note, intracranial empyema related to sinogenic infection is shown to have significantly more severe clinical presentation, a higher morbidity, and a longer duration of antibiotic therapy than that related to otogenic infection. Study findings allowed for the update and clarification of the institutional protocol, which now clearly demarcates the clinical presentation, biological evidence, radiology, surgical and medical treatments in children with oto-sinogenic IE.
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Affiliation(s)
- Mégane Raineau
- Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Ann-Marie Crowe
- Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Kevin Beccaria
- Pediatric Neurosurgery Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Romain Luscan
- Pediatric ENT Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Francois Simon
- Pediatric ENT Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Charles-Joris Roux
- Pediatric Radiology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Agnès Ferroni
- Clinical Microbiology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Manoelle Kossorotoff
- Pediatric Neurology Department, French Center for Pediatric Stroke, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Annie Harroche
- Clinical Hematology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Martin Castelle
- Pediatric Immunology Department, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Edith Gatbois
- Hospitalization at Home Department, Assistance Publique des Hôpitaux de Paris, Hôpital Armand Trousseau - Sorbonne Université, Paris, France.
| | - Marie Bourgeois
- Pediatric Neurology Department, French Center for Pediatric Stroke, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Mickaela Roy
- Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
| | - Stéphane Blanot
- Pediatric Intensive Care Unit, Assistance Publique des Hôpitaux de Paris, Hôpital Necker Enfants Malades - Université Paris Cité, Paris, France.
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Mohammad R, Maoldomhnaigh CÓ, Crimmins D. Clinical characteristics and outcomes of children with non-sinogenic Brain infections. Br J Neurosurg 2023:1-9. [PMID: 38149672 DOI: 10.1080/02688697.2023.2297877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/16/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Central Nervous System (CNS) suppurative infections are serious but rare conditions in the paediatric population. Data on long-term neurocognitive and quality of life outcomes in children recovering from these infections are lacking. METHODS A retrospective cohort review of children <16 years with non-sinogenic infections undergoing neurosurgery was conducted. Data for patients admitted to Children's Health Ireland at Temple St between 2008-2021 were analysed for clinical and microbiological profiles. Follow-up reviews evaluating neurological and academic sequelae and quality of life were performed. Categorical variables were analysed for unfavourable outcome with a p < 0.05 significance value. RESULTS Forty patients were included with a mean age of 4.5 years and equal gender distribution. Fever (68%) and vomiting (58%) were the most common presenting complaints. Only fourteen (35%) patients presented with the classic triad of fever, headache, and focal neurological deficit. Meningitis/Encephalitis was the most common cause of suppurative infection (40%). Predisposing factors included congenital heart disease (18%), prematurity (15%) and immunocompromised status (10%). More patients received an initial Burr hole aspiration (73%) than Craniotomy (27%). The re-operation rate was higher in the craniotomy group (45%) compared to the burr hole group (34%), but this was not statistically significant (p = 0.522). Four patients died (10%) including two intra-hospital deaths (5%). Male gender (p = 0.047) and multiple abscesses (p = 0.041) were associated with unfavourable outcome at discharge. Mobility impairment was the most affected determinant of quality of life. CONCLUSION CNS suppurative infections are associated with long-term neurocognitive sequelae in children. Multiple abscesses and male gender are associated with unfavourable GOS on discharge. Children are still left with mobility impairment (25%), personality changes (23%) and intellectual disability (18%) at an average of 5 years. Long-term follow up with multidisciplinary input is required. Further research should focus on evaluating long-term HRQoL in children.
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Affiliation(s)
- Retaj Mohammad
- Discipline of Surgery, School of Medicine, National University of Ireland, Galway, Ireland
- Department of Neurosurgery, Temple St Children's University Hospital, Ireland
| | - Cilian Ó Maoldomhnaigh
- Department of Paediatric Infectious Diseases, Temple St Children's University Hospital, Ireland
| | - Darach Crimmins
- Department of Neurosurgery, Temple St Children's University Hospital, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
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Hall BJ, Duddy JC, Apostolopoulou K, David R, Kurzbuch A, Nadkarni A, Trichinopoly Krishna S, Cooper B, Gouldbourne H, Hennigan D, Dawes W, Ellenbogen J, Parks C, Pettorini B, Sinha A, Mallucci C. Intracranial Empyemas in the COVID-19 Era: A New Phenomenon? A Paediatric Case Series and Review of the Literature. Pediatr Neurosurg 2023; 58:215-222. [PMID: 37393893 PMCID: PMC10614506 DOI: 10.1159/000531753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 06/01/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION We present the largest series of paediatric intracranial empyemas occurring after COVID-19 infection to date, and discuss the potential implications of the pandemic on this neurosurgical pathology. METHODS Patients admitted to our centre between January 2016 and December 2021 with a confirmed radiological diagnosis of intracranial empyema were retrospectively reviewed, excluding non-otorhinological source cases. Patients were grouped according to onset before or after onset of the COVID-19 pandemic and COVID-19 status. A literature review of all post-COVID-19 intracranial empyemas was performed. SPSS v27 was used for statistical analysis. RESULTS Sixteen patients were diagnosed with intracranial empyema: n = 5 prior to 2020 and n = 11 after, resulting in an average annual incidence of 0.3% prior to onset of the pandemic and 1.2% thereafter. Of those diagnosed since the pandemic, 4 (25%) were confirmed to have COVID-19 on recent PCR test. Time from COVID-19 infection until empyema diagnosis ranged from 15 days to 8 weeks. Mean age for post-COVID-19 cases was 8.5 years (range: 7-10 years) compared to 11 years in non-COVID cases (range: 3-14 years). Streptococcus intermedius was grown in all cases of post-COVID-19 empyema, and 3 of 4 (75%) post-COVID-19 cases developed cerebral sinus thromboses, compared to 3 of 12 (25%) non-COVID-19 cases. All cases were discharged home with no residual deficit. CONCLUSION Our post-COVID-19 intracranial empyema series demonstrates a greater proportion of cerebral sinus thromboses than non-COVID-19 cases, potentially reflecting the thrombogenic effects of COVID-19. Incidence of intracranial empyema at our centre has increased since the start of the pandemic, causes of which require further investigation and multicentre collaboration.
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Affiliation(s)
- Benjamin J Hall
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - John C Duddy
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Katerina Apostolopoulou
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Raenette David
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Arthur Kurzbuch
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Abhishek Nadkarni
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | | | - Ben Cooper
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Hayley Gouldbourne
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Dawn Hennigan
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - William Dawes
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Jonathan Ellenbogen
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Christopher Parks
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Benedetta Pettorini
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Ajay Sinha
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
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Yang RX, Chen B, Zhang Y, Yang Y, Xie S, He L, Shi J. Development of subdural empyema from subdural effusion after suppurative encephalitis: A case report. World J Clin Cases 2023; 11:2315-2320. [PMID: 37122516 PMCID: PMC10131016 DOI: 10.12998/wjcc.v11.i10.2315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/18/2023] [Accepted: 03/10/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Chronic subdural effusion is very common in the cranial imaging of middle-aged and older people. Herein, we report a patient misdiagnosed with subdural effusion, who was eventually diagnosed with chronic subdural empyema (SDE) caused by Streptococcus pneumoniae.
CASE SUMMARY A 63-year-old man was brought to our emergency room with a headache, vomiting, and disturbed consciousness. Computed tomography (CT) revealed a bilateral subdural effusion at the top left side of the frontal lobe. Cerebrospinal fluid examination after lumbar puncture indicated suppurative meningitis, which improved after anti-infective therapy. However, the patient then presented with acute cognitive dysfunction and right limb paralysis. Repeat CT showed an increase in left frontoparietal subdural effusion, disappearance of the left lateral ventricle, and a shift of the midline to the right. Urgent burr hole drainage showed SDE that was culture-positive for Streptococcus pneumoniae. His condition improved after adequate drainage and antibiotic treatment.
CONCLUSION Patients with unexplained subdural effusion, especially asymmetric subdural effusion with intracranial infection, should be assessed for chronic SDE. Early surgical treatment may be beneficial.
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Affiliation(s)
- Rui-Xi Yang
- Department of Infectious Diseases, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Bei Chen
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Yun Zhang
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Yao Yang
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Shu Xie
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Lin He
- Department of Psychosomatic Medicine, Mianyang Central Hospital, Mianyang 621000, Sichuan Province, China
| | - Jian Shi
- Department of Psychosomatic Medicine, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang 621000, Sichuan Province, China
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7
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Yazar U, Aydın ZGG, Özkaya AK, Kırımlı K, Güvercin AR. Subdural empyema in immunocompetent pediatric patients with recent SARS-CoV-2 positivity: case report. Childs Nerv Syst 2022; 39:1335-1339. [PMID: 36534133 PMCID: PMC9762647 DOI: 10.1007/s00381-022-05803-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Subdural empyema refers to the collection of purulent material in the subdural space and the most source of it is bacterial meningitis in infants while sinusitis and otitis media in older children. It has been very recently reported that coronaviruses (CoV) exhibit neurotropic properties and may also cause neurological diseases. CoV-related complications as hypercoagulability with thrombosis and associated inflammation, catastrophic cerebral venous sinus thrombose sand bacterial-fungal superinfections have been well documented in adult patients. Hereby, we describe 15-year-old and 12-year-old female children with subdural empyema after SARS-CoV2. The patients presented limitation of eye in the outward gaze, impaired speech, drowsiness, fever, vomiting and they also were tested positive for COVID-19. MRI indicated subdural empyema and surgical interventions were needed to relieve intracranial pressure and drain pus after receiving broad spectrum antibiotics treatments. The microbiological analysis of abscess material revealed Streptococcus constellatus which is extremely rare in an immunocompetent child and the patients received appropriate IV antibiotic therapy. Eventually, patients became neurologically intact. Pediatric patients with CoV infections should be closely monitored for neurological symptoms. Further research and more data on the correlation between CoV infections would provide better recognition and treatment options in an efficient manner in children.
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Affiliation(s)
- Uğur Yazar
- Department of Neurosurgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey.
| | - Zeynep Gökçe Gayretli Aydın
- Department of Pediatric Infectious Diseases, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ahmet Kağan Özkaya
- Department of Pediatrics and Department of Pediatric Emergency, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Kaan Kırımlı
- Department of Neurosurgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Ali Rıza Güvercin
- Department of Neurosurgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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8
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Ljubimov VA, Babadjouni R, Ha J, Krutikova VO, Koempel JA, Chu J, Chiarelli PA. Adolescent subdural empyema in setting of COVID-19 infection: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21506. [PMID: 36130569 PMCID: PMC9379715 DOI: 10.3171/case21506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/11/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Coronavirus disease 2019 (COVID-19) is an ongoing viral pandemic that has affected modern medical practice and can complicate known pathology. The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes symptoms that may mimic a viral pneumonia, with potential for serious sequelae, including acute respiratory distress syndrome, coagulopathy, multiorgan dysfunction, systemic vascular abnormalities, and secondary infection.
OBSERVATIONS
The authors describe a case of a 15-year-old boy who presented with a right subdural empyema and sinusitis while having active COVID-19 infection. The patient initially presented with left-sided weakness, frontal sinusitis, and subdural empyema. Emergent surgery was performed for evacuation of empyema and sinus debridement. Samples of purulent material within the subdural space were tested for SARS-CoV-2 by reverse transcriptase polymerase chain reaction. The patient had a successful recovery and regained the use of his right side after combined treatment. To our knowledge, this is the first reported case of a bacterial subdural empyema associated with frontal sinusitis in a coinfected patient with COVID-19 without evidence of COVID-19 intracranial infection.
LESSONS
A subdural empyema, which is a surgical emergency, was likely a superinfection caused by COVID-19. This, along with the coagulopathy caused by the virus, introduced unique challenges to the treatment of a known pathology.
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Affiliation(s)
- Vladimir A. Ljubimov
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Robin Babadjouni
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Joseph Ha
- Division of Neurosurgery, Children’s Hospital Los Angeles, Los Angeles, California
| | | | - Jeffrey A. Koempel
- Division of Otolaryngology, Children’s Hospital Los Angeles, Los Angeles, California
| | - Jason Chu
- Division of Neurosurgery, Children’s Hospital Los Angeles, Los Angeles, California
| | - Peter A. Chiarelli
- Division of Neurosurgery, Children’s Hospital Los Angeles, Los Angeles, California
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9
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Celi F, Saal-Zapata G. Subdural Empyema by Enterobacter cloacae: Case Report. INDIAN JOURNAL OF NEUROTRAUMA 2020. [DOI: 10.1055/s-0040-1718782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractInfections of the central nervous system are a medical emergency, potentially lethal and associated with increased morbidity and mortality. We present the case of a male with risk factors and clinical deterioration, in which the brain computed tomography scan showed a subdural collection following a head injury, which underwent surgical evacuation revealing a subdural empyema. The culture of the subdural collection yielded a positive result to Enterobacter cloacae.
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Affiliation(s)
- Fernando Celi
- Department of Neurosurgery, Hospital de Emergencias José Casimiro Ulloa, Miraflores, Lima, Perú
| | - Giancarlo Saal-Zapata
- Department of Neurosurgery, Hospital Nacional Guillermo Almenara Irigoyen - EsSalud, La Victoria, Lima, Perú
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10
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Bond E, Stadler JA. Subdural empyema caused by Morganella morganii. Surg Neurol Int 2020; 11:216. [PMID: 32874719 PMCID: PMC7451143 DOI: 10.25259/sni_136_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/10/2020] [Indexed: 11/04/2022] Open
Abstract
Background Morganella morganii is a species of Gram-negative enteric rod found in normal human gut flora. Pathologically, this most often presents as urinary tract infections, wound infections, and bacteremia. It is highly uncommon for M. morganii to be implicated in a central nervous system infection, with only 12 reported cases of parenchymal abscesses or meningitis. Case Description A previously healthy 13-month-old female presented with fever of unknown origin and had a witnessed seizure during evaluation. A large left subdural fluid collection was identified, and the patient underwent emergent burr hole drainage and subdural drain placement. Cultures demonstrated M. morganii empyema, and she subsequently completed a course of directed antibiotics. Six months following surgery, she has no further clinical or radiographic evidence of infection, seizures, or neurological sequelae. Conclusion We describe the first reported case of isolated subdural empyema caused by M. morganii. The child was successfully treated with the evacuation of the empyema and direct antibiotics with no lasting neurological injury.
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Affiliation(s)
- Evalina Bond
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, United States
| | - James A Stadler
- Department of Neurological Surgery, University of Wisconsin-Madison, Madison, Wisconsin, United States
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11
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Nguyen I, Urbanczyk K, Mtui E, Li S. Intracranial CNS Infections: A Literature Review and Radiology Case Studies. Semin Ultrasound CT MR 2020; 41:106-120. [DOI: 10.1053/j.sult.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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