Abstract
Background: Subdural empyema is an extremely rare and fatal
intracranial complication of chronic otitis media. Due to its rarity and
vague symptoms it is often diagnosed late if not completely missed;
specially in developing countries where the diagnostic modalities are
hardly available or accessible. To the best knowledge of the authors,
this is a preliminary reported case of a subdural empyema as a
complication of chronic otitis media in Eritrea, aiming to inform on the
clinical presentation, preferred diagnostic modalities, and the proper
management of such cases.
Case Report: An eight years old female patient presented with
fever, right ear purulent discharge, right post-auricular swelling, and
altered mental status of two weeks duration. Prior to her admission, she
had history of recurrent purulent discharge from her right ear for
almost 2 years, and had been diagnosed with chronic otitis media. Upon
admission her GCS was 13/15 which later on deteriorated to be 3/15 on
day three. MRI was done which showed a right fronto-tempo-parietal
subdural empyema with mass effect, shifting the midline to the left. She
was immediately started on broad spectrum antibiotics empirically. After
the diagnosis was made, craniotomy was done, and 30ml of pus was removed
from the subdural space. Culture and sensitivity of the pus obtained
intraoperatively was done but produced no yield. Hence, she was
continued on the empirically started antibiotics. The patient’s
condition was well improved by post-operative day 4.
Conclusion: It is important to have a high index of suspicion
of intracranial complications in patients with history of chronic otitis
media or other otologic symptoms, and neurologic manifestations.
Subdural empyema still being uncommon even among the intracranial
complications of COM, it is often missed. Hence, timely diagnosis with
MRI, immediate surgical evacuation of the empyema with the prolonged
administration of broad spectrum antibiotics is suggested.
Key words: Subdural empyema, chronic otitis media, Eritrea