Abstract:
Background. Intracranial infections secondary to ENT pathology are rare complications but
may cause severe neurological impairment and increased mortality. Untreated frontal
sinusitis can progress to subdural empyema and purulent meningoencephalitis, requiring
early diagnosis and prompt neurosurgical treatment.
Objective(s). Importance of rapid management in a severe case of purulent
meningoencephalitis with right subdural empyema, status epilepticus and Staphylococcus
spp. sepsis in an adolescent with untreated epilepsy.
Materials and methods. The 16-year-old patient was admitted in critical condition,
presenting with persistent fever, generalized tonic-clonic seizures, and altered
consciousness. Paraclinical investigations included brain imaging (MRI and CT), complex
microbiological analyses, multiplex PCR, repeated lumbar punctures and interdisciplinary evaluations.
Results. The patient’s final diagnosis included severe purulent meningoencephalitis, right
fronto-parietal subdural empyema, superior sagittal sinus thrombosis, and bacterial sepsis
caused by Staphylococcus spp. Treatment involved craniotomy for neurosurgical drainage,
targeted high-line antibiotic therapy based on antibiogram, anticonvulsant therapy,
corticosteroids, and complex intensive care. Paraclinical investigations were essential in
monitoring clinical progression. The patient’s evolution was slowly favorable, with complete
neurological recovery and no major sequelae at discharge, emphasizing the importance of a
multidisciplinary approach.
Conclusion(s). Severe neurological complications of untreated sinusitis, such as subdural
empyema and purulent meningoencephalitis, represent neurosurgical emergencies
requiring prompt intervention and multidisciplinary management to reduce mortality and
prevent permanent neurological sequelae.
