SHM Converge Scientific Abstract ePoster Gallery-The Unseen Danger: Diagnosing Intracranial Subdural Empyema

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This case describes a 75-year-old patient admitted with fever, headache, dizziness, myalgias, fatigue, dyspnea, and constipation. Initial evaluation showed mild fever, tachycardia, leukocytosis with neutrophilic predominance, mild hyponatremia, and acute kidney injury. Infectious workup was unrevealing except for a head CT showing sinus opacification suggestive of acute sinusitis. The patient was treated for sepsis with empiric antibiotics, and blood cultures later grew Streptococcus species.<br /><br />During hospitalization, the patient became more somnolent. A repeat neurologic exam revealed nuchal rigidity, prompting brain MRI, which diagnosed intracranial subdural empyema (ISE). Neurosurgical consultation was obtained.<br /><br />The case highlights that ISE is a rare but life-threatening intracranial infection occurring between the dura and arachnoid mater. It often presents with nonspecific symptoms such as fever, headache, vomiting, altered mental status, and seizures. The classic triad of fever, headache, and nausea occurs in fewer than half of cases. CT head can be falsely reassuring and may be normal in many patients, whereas MRI is more sensitive and considered the gold standard when ISE is suspected.<br /><br />Risk factors include recent sinus or ear infections and neurosurgical procedures. Common pathogens include Streptococcus and Staphylococcus species, though polymicrobial infections are also seen. The key lesson is that patients with sepsis plus headache or altered mental status require a complete neurologic examination, and a normal CT scan should not exclude intracranial infection. Early recognition is critical to reduce morbidity and mortality.

Asset Subtitle

Kristen Kipps

Meta Tag

Author List Kristen Kipps, Molly A. Kantor

Category Clinical Vignettes

Concept Intracranial Subdural Empyema

Concept Magnetic Resonance Imaging

Concept Headache

Concept Altered Mental Status

Concept Sinus Disease

Distinguished Non-Finalist

Presenter Organization Ucsf

Presenting Author Kristen Kipps

Track Adult

Keywords

intracranial subdural empyema

sepsis

sinusitis

headache

altered mental status

MRI

Streptococcus species

nuchal rigidity

acute kidney injury

neurologic examination

Intracranial Subdural Empyema

Magnetic Resonance Imaging

Headache

Altered Mental Status

Sinus Disease