Treatment-refractory Escherichia coli subdural empyema caused by infection of a chronic subdural hematoma in an infant

Jason A. Chen, Dimitrios Mathios, Joaquin Hidalgo, Alan R. Cohen

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Subdural empyema (SDE) is a neurosurgical emergency that is typically treated with surgical drainage, either by burr hole or by craniotomy. Escherichia coli is an uncommon cause of SDE and is associated with infection of a pre-existing subdural hematoma. Case report: We report the case of an otherwise healthy, immunocompetent 4-month-old infant girl with an E. coli-infected subdural hematoma. The infection persisted despite aggressive neurosurgical treatment that included drainage of the subdural space through burr holes and, subsequently, a wide craniotomy was performed. Ultimately, after 30 days, the SDE resolved with good neurological outcome. A review of prior literature indicates that infected subdural hematomas (including those caused by E. coli) are typically less aggressive and respond to burr hole drainage. Conclusion: We illustrate the fulminant progression of the SDE in the face of neurosurgical treatment. Our experience suggests lowering the threshold for wide craniotomy in these incompletely understood cases.

Original languageEnglish (US)
Pages (from-to)719-723
Number of pages5
JournalChild's Nervous System
Volume35
Issue number4
DOIs
StatePublished - Apr 5 2019

Keywords

  • Escherichia coli
  • Intracranial abscess
  • Subdural empyema
  • Subdural hematoma

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

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