Chen JC, Tan DH, Xue ZB, Yang SY, Li Y, Lai RL. Subdural empyema complicated with intracranial hemorrhage in a postradiotherapy nasopharyngeal carcinoma patient: A case report and review of literature. World J Clin Cases 2018; 6(14): 825-829 [PMID: 30510950 DOI: 10.12998/wjcc.v6.i14.825]
Corresponding Author of This Article
Run-Long Lai, MD, Chief Doctor, Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, No. 57, Changping Road, Shantou 515041, Guangdong Province, China. runlonglai@163.com
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Nov 26, 2018; 6(14): 825-829 Published online Nov 26, 2018. doi: 10.12998/wjcc.v6.i14.825
Subdural empyema complicated with intracranial hemorrhage in a postradiotherapy nasopharyngeal carcinoma patient: A case report and review of literature
Jun-Chen Chen, Dian-Hui Tan, Ze-Bin Xue, Sen-Yuan Yang, Yong Li, Run-Long Lai, Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, Shantou 515041, Guangdong Province, China
Author contributions: Chen JC and Tan DH contributed equally to this work and should be considered as co-first authors; Chen JC and Tan DH participated in the patient treatment and wrote the manuscript; Xue ZB and Yang SY collected the clinical data and performed the literature review; Li Y and Lai RL performed the operation; Lai RL helped to design and revise the paper.
Informed consent statement: Written informed consent was obtained from the patient and her family.
Conflict-of-interest statement: All the authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Run-Long Lai, MD, Chief Doctor, Department of Neurosurgery, First Affiliated Hospital of Shantou University Medical College, No. 57, Changping Road, Shantou 515041, Guangdong Province, China. runlonglai@163.com
Telephone: +86-754-88258290 Fax: +86-754-88259850
Received: August 4, 2018 Peer-review started: August 5, 2018 First decision: August 31, 2018 Revised: September 21, 2018 Accepted: October 12, 2018 Article in press: October 11, 2018 Published online: November 26, 2018
ARTICLE HIGHLIGHTS
Case characteristics
A 64-year-old woman presented with a progressive headache, deteriorating consciousness, difficulty speaking, and weakness in the left extremities for 2 d.
Clinical diagnosis
Subdural empyema complicated with intracranial hemorrhage.
Differential diagnosis
Chronic or subacute subdural hematoma.
Laboratory diagnosis
While a culture of the operative empyema grew Corynebacterium, blood culture was negative.
Imaging diagnosis
A cranial CT showed a hypodense crescent-shaped accumulation of extra-axial fluid in addition to a local hyperdense lesion over the right hemisphere. There was a marked midline shift, and a tentorial herniation had formed.
Treatment
A burr-hole craniostomy with continuous closed system drainage and use of antibiotics were administered to the patient.
Related reports
A patient presenting with subdural empyema after completion of concurrent chemoradiotherapy for stage IVB nasopharyngeal carcinoma (NPC) has been reported in detail by Dr. Chan from Singapore National University Hospital in 2006.
Term explanation
Burr-hole craniotomy under CT or MRI guidance is an invasive surgical approach for chronic subdural hematoma or subdural empyema. Compared with craniotomy, burr-hole drainage can be performed under local anesthesia and is a less invasive surgical choice for patients with old age or poor health condition.
Experiences and lessons
Subdural empyema is a rare but life-threatening complication in postradiotherapy NPC. It results from hematogenous seeding opportunistic pathogenic bacteria rather than sinusitis. Subdural empyema can mimic chronic or subacute subdural hematoma because of the similar clinical manifestations and imaging findings.
