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Child's Nervous System
Published in: Child's Nervous System 4/2019

01-04-2019 | Case Report

Treatment-refractory Escherichia coli subdural empyema caused by infection of a chronic subdural hematoma in an infant

Authors: Jason A. Chen, Dimitrios Mathios, Joaquin Hidalgo, Alan R. Cohen

Published in: Child's Nervous System | Issue 4/2019

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Abstract

Introduction

Subdural empyema (SDE) is a neurosurgical emergency that is typically treated with surgical drainage, either by burr hole or by craniotomy. Escherichia coli is an uncommon cause of SDE and is associated with infection of a pre-existing subdural hematoma.

Case report

We report the case of an otherwise healthy, immunocompetent 4-month-old infant girl with an E. coli-infected subdural hematoma. The infection persisted despite aggressive neurosurgical treatment that included drainage of the subdural space through burr holes and, subsequently, a wide craniotomy was performed. Ultimately, after 30 days, the SDE resolved with good neurological outcome. A review of prior literature indicates that infected subdural hematomas (including those caused by E. coli) are typically less aggressive and respond to burr hole drainage.

Conclusion

We illustrate the fulminant progression of the SDE in the face of neurosurgical treatment. Our experience suggests lowering the threshold for wide craniotomy in these incompletely understood cases.
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Metadata
Title
Treatment-refractory Escherichia coli subdural empyema caused by infection of a chronic subdural hematoma in an infant
Authors
Jason A. Chen
Dimitrios Mathios
Joaquin Hidalgo
Alan R. Cohen
Publication date
01-04-2019
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 4/2019
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-018-4003-7

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