Agitation and Encephalopathy in a 16 Year Old: An Unusual Presentation of Subdural Empyema and Pott's Puffy Tumor

1Texas Tech University School of Medicine, Lubbock, TX

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 369

Case Presentation:

The patient is a 16‐year‐old male who was transferred to a tertiary‐care center after being evaluated in a local emergency department (ED) for acute onset of confusion and agitation. He was restrained by law enforcement and brought to the local ED by ambulance. Prior to the presentation he had a 2‐day history of nausea, vomiting, and headache for which he was treated symptomatically by the local ED. He had been treated with a partial course of oral antibiotics for sinusitis approximately 4–6 weeks prior to presentation. He had a normal head contrast‐enhanced computed tomography (CT) and negative drug screen at the referring hospital. At the time of admission he had a nonfocal neurologic exam, with ongoing agitation and disorientation. Cerebrospinal fluid studies were obtained showing a white blood cell count of 535 with a neutrophilic predominance. The patient was treated empirically with broad‐spectrum parenteral antibiotics. On the second day of admission he developed acute facial swelling. Magnetic resonance imaging (MRI) at that time revealed small bilateral sub‐dural empyema and subperiosteal abscess of the frontal bone consistent with Pott's puffy tumor. He was treated with surgical drainage and a prolonged course of intravenous antibiotics. After inpatient rehabilitation he recovered to function near his baseline.

Discussion:

Subdural empyema and Pott's puffy tumor are rare complications of sinus disease. Intracranial complications of partially treated sinus disease occur uncommonly in children. Most children with subdural empyema present with nonspecific complaints such as headache, fever, nausea, and vomiting. Early recognition of intracranial extension of sinusitis can minimize the morbidity and the potential for a fatal outcome. Treatment consists of surgical drainage and appropriate parenteral antibiotics.

Conclusions:

We present this case to highlight an unusual presentation of subdural empyema and extensive complications secondary to partially treated sinus disease.

Disclosures:

K. Pollard ‐ none; S. Madrid ‐ none; F. Levent ‐ none; L. Johnson ‐ none

To cite this abstract:

Pollard K, Madrid S, Levent F, Johnson L. Agitation and Encephalopathy in a 16 Year Old: An Unusual Presentation of Subdural Empyema and Pott's Puffy Tumor. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 369. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/agitation-and-encephalopathy-in-a-16-year-old-an-unusual-presentation-of-subdural-empyema-and-potts-puffy-tumor/. Accessed June 17, 2019.

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