The pediatric headache that would not go away

Pediatr Emerg Care. 2013 Dec;29(12):1283-6. doi: 10.1097/PEC.0000000000000035.


We describe the clinical presentation, radiographic findings, management, and outcome of a subdural empyema in a 14-year-old male with history of recent partially treated acute sinusitis. Subdural empyema is a rare but life threatening complication, usually following paranasal sinusitis, otitis media, mastoiditis, cranial surgery, a skull fracture, or from distant spread from sites such as a pulmonary infection. The initial evaluation should include a thorough history and physical examination, complete blood count, electrolytes, C-reactive protein, erythrocyte sedimentation rate, chest x-ray, urinalysis, and neuroimaging of the brain with intravenous contrast. If a subdural empyema is identified, then intravenous antibiotics should be initiated, and immediate neurosurgical consultation should be obtained to consider operative drainage.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use
  • Bacteremia / diagnosis
  • Bacteremia / drug therapy
  • Consciousness Disorders / etiology
  • Diagnostic Errors*
  • Emergency Service, Hospital
  • Empyema, Subdural / complications
  • Empyema, Subdural / diagnosis*
  • Empyema, Subdural / microbiology
  • Empyema, Subdural / therapy
  • Fever / etiology
  • Frontal Sinusitis / complications*
  • Frontal Sinusitis / diagnostic imaging
  • Frontal Sinusitis / microbiology
  • Gram-Positive Bacterial Infections / diagnosis*
  • Gram-Positive Bacterial Infections / etiology
  • Gram-Positive Bacterial Infections / therapy
  • Headache / etiology*
  • Hematoma, Subdural / diagnosis
  • Humans
  • Male
  • Migraine Disorders / diagnosis
  • Peptostreptococcus / isolation & purification*
  • Tomography, X-Ray Computed*


  • Anti-Bacterial Agents