case_images: PMC11731581_01
case_images: Brain CT scan without contrast (A) air-fluid level in left maxillary sinus suggestive of sinusitis (B) preoperatively showed A hypoattenuating extra-axial fluid collection with a diameter of 7.5 mm over the right hemisphere with a compressive effect on the lateral ventricle and midline shift of 7 mm into the left side was present, considered as subdural empyema. (C) Early postoperative CT scan showed reduced midline shift and drainage of a subdural extra-axial fluid collection, which was diagnosed as subdural empyema. Contrast-enhanced brain CT scan (D) 6 months after surgery showed noncommunicating hydrocephalus.
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case_images: PMC11731581_01_gr1.jpg
case_images: fig0001
case_images: C-reactive protein values were abnormally high. CT imaging demonstrated opacifications containing air-fluid level in maxillary and frontal sinuses, suggesting acute sinusitis (Fig. 1). A hypoattenuating extra-axial fluid collection with a diameter of 7.5 mm over the right hemisphere with compressive effect on lateral ventricle and midline shift of 7 mm into left side was present, considered as subdural empyema and pachymeningitis probably secondary to acute frontal and maxillary sinusitis (Fig. 1). The early postoperative brain CT scan revealed reduced midline shift and drainage of a subdural extra-axial fluid collection, which was diagnosed as subdural empyema (Fig. 1). A contrast-enhanced brain CT scan was obtained and showed noncommunicating hydrocephalus (Fig. 1).
case_images: PMC11731581_02
case_images: Noncontrast Brain CT scan (A) preoperatively showed a hypodense rim in right frontotemporoparietal with subtle midline shift to the left. Contrast enhanced brain CT scan (B) preoperatively showed a hypodense rim in right frontotemporoparietal with enhancement of adjacent pia matter in favor of a subdural inflammatory collection. (C) Early postoperative CT scan showed right frontotemporoparietal craniectomy, no midline shift with the drainage of a subdural extra-axial fluid collection, which was diagnosed as subdural empyema, (D) One-month postoperatively CT scan showed right frontotemporoparietal cranioplasty with normal brain tissue.
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case_images: PMC11731581_02_gr2.jpg
case_images: fig0002
case_images: CT scan demonstrated a hypodense rim in right frontotemporoparietal with subtle midline shift to the left. Contrast enhanced brain CT scan showed hypodense rim in right frontotemporoparietal with enhancement of adjacent pia matter in favor of a subdural inflammatory collection (Fig. 2). The early post operative CT scan showed right frontotemporoparietal craniectomy, no midline shift with the drainage of a subdural extra-axial fluid collection, which was diagnosed as subdural empyema (Fig. 2).
case_images: PMC11731581_03
case_images: Noncontrast Brain CT scan (A) preoperatively showed a hypodense rim in right frontotemporoparietal with subtle midline shift to the left. (B) Early postoperative CT scan showed right frontotemporoparietal craniectomy, no midline shift with the drainage of a subdural extra-axial fluid collection, which was diagnosed as subdural empyema, (C) One-month postoperatively CT scan showed right frontotemporoparietal cranioplasty with normal brain tissue. (D) Six-month postoperatively CT scan showed normal brain tissue.
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case_images: PMC11731581_03_gr3.jpg
case_images: fig0003
case_images: C-reactive protein values were abnormally high (ESR=100, CRP=250). CT imaging demonstrated a hypodense rim in the right frontotemporoparietal, similar to case I (Fig. 3). The early post operative CT scan showed right frontotemporoparietal craniectomy, no midline shift with the drainage of a subdural extra-axial fluid collection, which was diagnosed as subdural empyema (Fig. 3).