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Question: Neuro
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You are seeing a 12 year old child that presents with altered mental status, fever, and history of headache and vomiting before the decline in mental status. The patient has a seizure on arrival to the ED, which resolve with lorazepam IV. The CT scan shows evidence of a subdural fluid collection. The lumbar puncture results show a neutrophilic pleocytosis with an elevated protein. Gram stain is negative.
Kelly March 4, 2022 - 11:59 pm
C) Patients commonly present with acute neurologic abnormalities such as altered mental status, seizure, or stroke-like symptoms
In young children < 1 year, subdural empyema usually results from an extension of bacterial meningitis. However, in older children, sinusitis is the most common underlying cause. Any child with sinusitis on CT and concerning neurologic symptoms as listed in C (seizure is a presenting symptom in 40%) should be evaluated immediately for subdural empyema. Gram stain and culture of CSF are typically negative. Head CT can be normal in up to 50%, and MRI with contrast is the preferred imaging study. Antibiotics should never be withheld to complete an LP. Neurosurgery should be consulted early; many patients will require surgical drainage.