Sterile subdural empyema: an unusual presentation

Description

A 66-year-old man presented to the emergency department with a 6-week history of progressively worsening generalised weakness and gait instability. Physical examinations revealed a low-grade fever of 37.7°C. In addition, the patient was found to have very poor dentition and bilateral sensorineural hearing reduction with no other focal neurological deficit. Laboratory investigations showed a white cell count of 25.8 10⁹/L (Ref: 4–10.8 10⁹/L), predominately neutrophils at 84% (Ref: 36%–75%). A CT of the head was negative for any acute processes and a subsequent MRI of the head with and without contrast was consistent with bilateral frontal subdural empyema (SDE) and ventriculitis (figure 1). He was started initially on vancomycin, ceftriaxone and metronidazole and he underwent bilateral burr hole biopsy and drainage of a thick, creamy white fluid within 2 days of starting the antibiotics. Pathological findings were consistent with an abscess; however, the microbiological culture failed to...

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