Subdural Empyema and Pneumocephalus From Chronic Polypoid Sinusitis in an Elderly Woman With Rapid Neurological Recovery - A Report of a Rare Case

Sep 29, 2026

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Rare coexistence of subdural empyema and atraumatic pneumocephalus is presented in a 76-year-old woman with rapid neurological recovery. The patient was found unresponsive, with fever and laboratory evidence of systemic inflammation. Non-contrast CT showed a small subdural collection with intracranial air foci and concurrent otitis media, mastoiditis, and pansinusitis. Lumbar puncture demonstrated xanthochromic CSF with elevated protein and WBC, and Streptococcus pneumoniae was confirmed. Emergency craniotomy drained purulent material followed by ENT surgery, leading to full recovery.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages6

Reading Time15 min

AccessFree to download

Background

Case Report

Conclusions

e-ISSN 1941-5923 © Am J Case Rep, 2025; 26: e949999 DOI: 10. 12659/AJCR.949999 Received: 2025.05.25 Accepted: 2025.09.02 Available online: 2025.11.15 Published: 2025.12.16 Subdural Empyema and Pneumocephalus From Chronic Polypoid Sinusitis in an Elderly Woman With Rapid Neurological Recovery: A Report of a Rare Case Authors’ Contribution: Study Design A Data Collection B Statistical Analysis C Data Interpretation D Manuscript Preparation E Literature Search F Funds Collection G ABCDEF BCEF E E E E E 1 1 1 1 2 3 1 John Martinez Elizabeth Nagidi Mark Rigby Lina Ataya Aftab Macksood Ghiath Bayasi Kelsee Rotondo 1 Department of Internal Medicine, Henry Ford Genesys, Grand Blanc, MI, USA 2 Department of Radiology, Henry Ford Genesys, Grand Blanc, MI, USA 3 Department of Pulmonary and Critical Care, Henry Ford Genesys, Grand Blanc, MI, USA Corresponding Author: John Martinez, [e-mail:](e-mail: jmarti80@hfhs.org)[ jmarti80@hfhs.org](e-mail: jmarti80@hfhs.org)[ ](e-mail: jmarti80@hfhs.org)[Financial support:](Financial support: None declared)[ None declared](Financial support: None declared) [Conflict of interest:](Conflict of interest: None declared)[ None declared](Conflict of interest: None declared) Patient: Female, 76-year-old Final Diagnosis: Subdural empyema Symptoms: Altered mental state Clinical Procedure: Craniotomy • ethmoidectomy • lumbar puncture Specialty: General and Internal Medicine Objective: Rare coexistence of disease or pathology 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. Keywords: Craniotomy • Empyema, Subdural • Infections • Pneumocephalus • Sinusitis • Streptococcus pneumoniae Full-text PDF: [https://www.amjcaserep.com/abstract/index/idArt/949999](https://www.amjcaserep.com/abstract/index/idArt/949999) 2018 — 6 22 Publisher’s note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher This work is licensed under Creative Common AttributionNonCommercial-NoDerivatives 4.0 Int

FAQs

What clinical features suggested severe intracranial infection in this case?

Altered mental state with fever and systemic inflammation supported a high suspicion for intracranial infection. CT also demonstrated both a subdural collection and intracranial air foci alongside sinus and ear pathology.

How was the diagnosis of subdural empyema and the infectious organism confirmed?

Non-contrast CT identified a small subdural collection with intracranial air. Lumbar puncture showed xanthochromic CSF with elevated protein and WBC, and CSF culture/urine antigen confirmed Streptococcus pneumoniae.

What treatments led to the rapid neurological recovery?

Emergency craniotomy drained 75 cc of purulent material, followed by ENT interventions including maxillary antrostomy, ethmoidectomy, and tympanostomy. Prompt multidisciplinary management resulted in full neurological recovery.

Sep 29, 2026

Uploaded by Elsa