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The Pediatric Headache That Would Not Go Away

Dunn, Bryan MD; McCalla, Chad MD; Hiestand, Brian MD; O’Brien, Mary Claire MD

doi: 10.1097/PEC.0000000000000035
Illustrative Cases

We describe the clinical presentation, radiographic findings, management, and outcome of a subdural empyema in a 14-year-old male with history of recent partially treated acute sinusitis. Subdural empyema is a rare but life threatening complication, usually following paranasal sinusitis, otitis media, mastoiditis, cranial surgery, a skull fracture, or from distant spread from sites such as a pulmonary infection. The initial evaluation should include a thorough history and physical examination, complete blood count, electrolytes, C-reactive protein, erythrocyte sedimentation rate, chest x-ray, urinalysis, and neuroimaging of the brain with intravenous contrast. If a subdural empyema is identified, then intravenous antibiotics should be initiated, and immediate neurosurgical consultation should be obtained to consider operative drainage.

From the Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.

Disclosure: The authors declare no conflict of interest.

Reprints: Bryan Dunn, MD, Department of Emergency Medicine, Wake Forest University School of Medicine, 1200 Medical Center Blvd, Winston-Salem, NC 27157 (e-mail: dunnb@ecu.edu).

© 2013 Lippincott Williams & Wilkins, Inc.