SUBDURAL EMPYEMA IN A 7-MONTH-OLD INFANT WITH COMMUNICATING

HYDROCEPHALUS THAT MANIFESTED IN STATUS EPILEPTICUS: A CASE REPORT

Nurfajrin Utami Ansari, Urfianty, Hadia Angriani

Pediatric Departement, Faculty of Medicine, Hasanuddin University
Dr.Wahidin Sudirohusodo Hospital, Makassar, Indonesia

OBJECTIVE: Subdural empyema is a loculated collection of pus in the subdural space between
the dura mater and the arachnoid. Usually affects children and young adults. Subdural
empyema most often occurs due to the direct extension of local infection. Clinical presentation
of subdural empyema usually presents with signs and symptoms of infection; however, it can
also be asymptomatic. Intracranial infection can lead to accumulation of cerebrospinal fluid,
progressing to hydrocephalus. Some of the symptoms that can be seen include fever,
headache, nausea, vomiting, focal neurological deficits, seizures, and mental status changes.
Seizure, that progress to status epilepticus is a neurological emergency that requires immediate
evaluation and management to prevent significant morbidity or mortality. The aim of this study is
to report subdural empyema in a 7-month-old infant with communicating hydrocephalus that
manifested in status epilepticus.

CASE: A 7-month-old baby girl was admitted with complaints of seizures with frequency of 4
times, focal, duration of more than 30 minutes and after the seizure the child was unconscious.
There was fever along with stiffness in the body experienced since 1 month before. History of
otorrhoea was reported. Physical examination showed no abnormalities of cranial nerves, no
neck stiffness, increased motor tone, increased physiological reflexes and pathological reflexes
within normal limits. The laboratory examination revealed leukocytosis, anemia, and an increase
of liver enzymes. MSCT scan of the head without contrast showed a hypodense periventricular
III lesion on the right side with a suspected abscess and hydrocephalus communicans with
transependymal edema. The patient was treated with antipyretics, antibiotics, anticonvulsants
and insertion of VP shunt. Patient’s condition was improved after several days.

CONCLUSION: Subdural empyema is an intracranial infection that develops progressively. The

development of hydrocephalus and manifestation of status epilepticus require immediate
medical intervention and surgery. The patient in this case had an improvement in her condition
after appropriate therapy was given.

Keywords: Infant; Hydrocephalus; Status epilepticus; Subdural empyema