Subdural Empyema and Pneumocephalus From Chronic Polypoid Sinusitis in an Elderly Woman With Rapid Neurological Recovery: A Report of a Rare Case.
Recommended Citation
Martinez J, Nagidi E, Rigby M, Ataya L, Macksood A, Bayasi G, and Rotondo K. Subdural Empyema and Pneumocephalus From Chronic Polypoid Sinusitis in an Elderly Woman With Rapid Neurological Recovery: A Report of a Rare Case. Am J Case Rep 2025;26:e949999.
Document Type
Article
Publication Date
12-16-2025
Publication Title
Am J Case Rep
Keywords
Humans, Female, Aged, Pneumocephalus, Empyema, Subdural, Tomography, X-Ray Computed, Chronic Disease, Pneumococcal Infections, Sinusitis
Abstract
BACKGROUND: Subdural empyema (SDE) is a rare, life-threatening intracranial infection characterized by pus accumulation between the dura and arachnoid mater. It is most commonly associated with sinusitis, typically affecting young males. The presence of pneumocephalus without trauma or surgery is exceedingly rare and should raise concern for intracranial infection. Early diagnosis through neuroimaging and prompt multidisciplinary intervention are crucial for preventing morbidity and mortality.
CASE REPORT: We present a case of SDE and atraumatic pneumocephalus in a 76-year-old woman who was found unresponsive at home. Laboratory tests revealed leukocytosis, elevated inflammatory markers, and fever. Non-contrast computed tomography (CT) showed a 2-3 mm subdural collection with intracranial air foci, along with evidence of otitis media, mastoiditis, and pansinusitis. Lumbar puncture revealed xanthochromic cerebrospinal fluid (CSF) with elevated protein and white blood cells (WBC). Streptococcus pneumoniae was confirmed by CSF culture and urine antigen. She underwent emergency craniotomy, draining 75 cc of purulent material, followed by the ear, nose, and throat (ENT) intervention with maxillary antrostomy, ethmoidectomy, and tympanostomy. She experienced a full neurological recovery.
CONCLUSIONS: This case underscores the importance of high clinical suspicion and early imaging in elderly patients with altered mental status and sinus pathology. Atraumatic pneumocephalus in non-surgical patients may signal severe intracranial infection. Timely, multidisciplinary management led to rapid recovery, and this case adds to the limited literature on pneumococcal SDE with pneumocephalus in elderly women with chronic sinusitis.
Medical Subject Headings
Humans; Female; Aged; Pneumocephalus; Empyema, Subdural; Tomography, X-Ray Computed; Chronic Disease; Pneumococcal Infections; Sinusitis
PubMed ID
41399183
Volume
26
First Page
949999
Last Page
949999
