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A subdural empyema of odontogenic origin is an uncommon, but significant sequela of dental disease with associated morbidity. This article discusses the case of a 15-year-old boy who presented with a subdural empyema of odontogenic origin. The case highlights the multidisciplinary care required to manage such cases, including the involvement of the dental team. It discusses the complexities in its diagnosis and management as well as the associated morbidity and mortality.
CPD/Clinical Relevance: Subdural empyema of odontogenic origin has implications for the dental team in terms of prevention and management of dental disease.
Article
An intracranial empyema is a pus collection in the subdural or extradural space. This results from the spread of infection from one anatomical space to another with otitis, frontal sinusitis or a post-surgical/post-traumatic direct inoculation providing the source.1 The clinical presentation of a subdural empyema can vary, but timely management is required to ensure the best outcome for the patient.
A 15-year-old boy attended accident and emergency (A&E) reporting a 3-day history of fever, myalgia, vomiting, photophobia, and headaches. He had an otherwise unremarkable medical history. The initial medical diagnosis was of a viral upper respiratory tract infection for which he was prescribed a course of oral antibiotics and advised to arrange a COVID-19 swab.
He re-presented to A&E 2 days later with a worsening fever and myalgia, urinary incontinence, and reduced mobility. On examination, he had an evolving neurological deficit with left leg weakness, a convergent squint, and a visual field defect–all suggestive of raised intracranial pressure. He also demonstrated pyrexia and an increased respiratory rate. He was admitted for further investigations and the empirical treatment of sepsis, with intravenous antibiotics, antivirals and dexamethasone, was initiated.
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