case_images: PMC10904082_01
case_images: Non-contrast-enhanced cranial MRI at admission.. (A) Axial T1 with a subtle extra-axial left parafalcine subdural empyema. (B) Axial FLAIR with an air-fluid level on the left frontal sinus consistent with acute sinusitis. Notice the left frontal subdural empyema causing a slight anterior midline shift.. FLAIR: fluid-attenuated inversion recovery; MRI: magnetic resonance imaging
case_images: cureus-0016-00000053249-i01.jpg
case_images: PMC10904082_01_cureus-0016-00000053249-i01.jpg
case_images: FIG1
case_images: Afterward, he was admitted to the intensive care unit (ICU), and non-contrast-enhanced magnetic resonance imaging (MRI) confirmed the presence of an SDE with a slight mass effect (Figure 1).
case_images: Contrast-enhanced cranial MRI three weeks post-craniectomy.. T1 fat-saturated image after intravenous contrast showing a large midline extra-axial fluid collection consistent with relapsed subdural empyema.. MRI: magnetic resonance imaging
case_images: cureus-0016-00000053249-i02.jpg
case_images: PMC10904082_01_cureus-0016-00000053249-i02.jpg
case_images: FIG2
case_images: ICU, the patient's condition slowly recovered, and follow-up imaging showed a favorable progression. In the third week post-admission, the patient's clinical condition relapsed with fever and rising inflammatory laboratory parameters; urgent contrast-enhanced MRI was consistent with relapse of the SDE with concerning findings for frontal bone osteomyelitis (Figure 2).
case_images: Contrast-enhanced cranial MRI six months post-admission.. (A) Axial FLAIR with substantial cortico-subcortical encephalomalacia causing a slight ipsilateral midline shift. (B) Axial T1 fat-saturated contrast-enhanced image with no signs of subdural empyema relapse. Passive left ventricle enlargement (occipital horn) and chronic left frontal sinusitis can be noted.. FLAIR: fluid-attenuated inversion recovery; MRI: magnetic resonance imaging
case_images: cureus-0016-00000053249-i03.jpg
case_images: PMC10904082_01_cureus-0016-00000053249-i03.jpg
case_images: FIG3
case_images: At the time of discharge (six months post-admission), the patient exhibited persistent mild right-sided hemiparesis and expressive aphasia, and the pre-discharge MRI revealed extensive left cortico-subcortical encephalomalacia with stable brain herniation through the craniectomy defect and passive left ventricle enlargement (Figure 3).