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///2013 Abstract Details
2013 Abstract Details2019-08-02T16:57:45-05:00

SUBDURAL EMPYEMA DURING PREGNANCY

Abstract Number: F 52
Abstract Type: Case Report/Case Series

Olatubosun N Dennis MD1 ; stephanie Grant MD2; Barbara Leighton MD3

SUBDURAL EMPYEMA DURING PREGNANCY

Olatubosun Dennis, M.D., Stephanie N. Grant, M.D., Barbara Leighton, M.D.

Washington University, St. Louis, MO

A 38 year-old African-American G6P5005 woman presented at 26 weeks gestational age with altered mental status and right-sided weakness. Magnetic resonance imaging (MRI) demonstrated an extensive bifrontal subdural empyema. The patient’s medical history was notable for only chronic sinusitis. An emergent craniotomy was performed with evacuation of the subdural empyema and an intracerebral abscess plus removal of a frontal bone flap for osteomyelitis. An intraoperative culture grew Streptococcus anginosus (milleri) and six weeks of intravenous ceftriaxone and oral metronidazole began. However, a follow-up MRI five weeks after surgery demonstrated recurrence of the subdural empyema with a midline shift. She again had emergent drainage of the abscess. Her antibiotics were then changed to intravenous meropenem. A follow-up MRI demonstrated no residual subdural empyema. Six days after completing her antibiotics, the patient presented at 40 1/7 weeks gestational age for induction of labor secondary to fetal heart rate decelerations. On exam, the patient was alert and oriented with no focal neurologic deficits. An epidural catheter was placed for labor analgesia. The patient had an uncomplicated spontaneous vaginal delivery and had no complications from the epidural catheter placement.

Intracranial subdural empyema is a rare disease requiring surgical drainage that usually follows paranasal sinusitis and primarily affects adolescent and young adult men.(1,2) Twenty-nine patients described in two case series have the following characteristics: 90% of the patients were male, 65% of the bacterial isolates were streptococcal species, 45% of patients developed a second abscess and required a second drainage operation, and 45% of patients had residual focal neurologic deficits.(1,2) There are only three published case reports of intracranial subdural empyema in parturients, one of whom also had bacterial meningitis and two of whom presented post-partum with no antecedent infections.(3)

It is fortunate that our patient had recovered from her infection before delivery, for dural puncture is contraindicated in the presence of subdural empyema due to the risk of cerebral herniation, which has been reported.(1) If the infection had necessitated preterm delivery, labor without neuraxial anesthesia or cesarean delivery under general anesthesia would have been required.

1. Dill SR, Cobbs CG, McDonald CK. Subdural empyema: Analysis of 32 cases and review. Clin Infect Dis 1995;20:372-86.

2. Kombogiorgas D, Seth R, Athwal R, Modha J, Singh J. Suppurative intracranial complications of sinusitis in adolescence. Br J Neurosurg 2007;21:603-9.

3. Bhatoe HS. Puerperal subdural empyema. Postgrad Med J 1996;72:317-318.

SOAP 2013