Sinogenic Subdural Empyema in a Ten-Year-Old Boy with Sickle Cell Anemia

• 作者: Daniel Memia-Zolo Fran?ois Lengelle Mehdi Mejdoubi Nidal Salloum Norbert Manzo Raoul Santiago Remus Stegaru Ulf Nestler William Cécile
• 来源期刊: 现代神经外科学进展(英文)
• 学科: 医学
• 关键词: Nasal SINUSITIS SICKLE Cell Anemia STREPTOCOCCUS PNEUMONIAE SUBDURAL EMPYEMA
• 年，卷（期）: 2013,（4）
• 页码范围: 53-58
• 页数: 6页
• 分类号: R73

摘要

Objective: Sinogenic subdural empyema remains a neurosurgical emergency, even in the antibiotic era. Sickle cell disease is one of the most frequent hereditary diseases, with an incidence of around 4 in 1000 newborns, which necessitates special considerations before a neurosurgical intervention. Case Description: The case of a 10-year-old boy with sickle cell disease type HbSC is reported, who presented with meningitis about ten days after a nasal sinusitis. CT and MRI showed subdural empyema and immediate intravenous antibiotic treatment was started. The patient received partial exchange transfusion. Craniotomy allowed evacuation of empyema and repairment of a frontobasal dural defect. Endoscopic evacuation of the paranasal sinuses was done in the same anesthesia. After initial good recovery, the patient developed right sided paresis with epileptic seizures a few days later. CT scan revealed three distant empyema recurrencies which were evacuated in a second neurosurgical intervention. The child recovered without neurologic deficit, and control MRI examinations three and twelve months after surgery found frontal and parietal dural thickening as sequelae. Conclusion: Urgent neurosurgical interventions in the presence of sickle cell anemia require special anesthesiologic preparations. An immediate, multidisciplinary approach can lead to a good outcome in these life-threatening situations.