A Rare Case Report of Subdural Empyema as a Severe Intracranial Complication of Maxillary Sinusitis

Abstract

Subdural empyema is a rare but potentially life-threatening intracranial complication of bacterial sinusitis. This case report described a 34-year-old man who presented with progressive impairment of consciousness following generalized tonic-clonic seizures. The patient had a three-month history of sinusitis and subsequently developed foul-smelling purulent nasal discharge, worsening headache, and high-grade fever. Neurological examination revealed impaired consciousness and nuchal rigidity without focal motor deficits. Laboratory investigations demonstrated leukocytosis, neutrophilia, an elevated neutrophil-to-lymphocyte ratio, reactive thrombocytosis, and mild anemia. Contrast-enhanced head computed tomography revealed a right frontoparietotemporal crescent-shaped subdural collection with peripheral enhancement, cerebral edema, a 0.7-centimeter midline shift, subfalcine herniation, and associated meningoencephalitis. Opacification of multiple paranasal sinuses, including the right maxillary sinus, supported sinusitis as the infectious source. The patient was treated with intravenous broad-spectrum antibiotics, anticonvulsant therapy, corticosteroids, and supportive management. Following multidisciplinary evaluation, conservative treatment was continued without surgical drainage because the patient showed progressive clinical improvement. His consciousness improved, no recurrent seizures occurred, and his headache subsided. The patient was discharged in stable neurological condition. This case highlighted the importance of early recognition, prompt neuroimaging, appropriate antimicrobial therapy, and multidisciplinary management in patients with sinusitis who developed neurological deterioration.