2023 Volume 28 Issue 1 Pages 46-
The patient was a 15-year-old boy. The patient initially had chills, and after 13 days, headache and fever appeared. On the 15th day of onset, right eyelid swelling and diplopia occurred, and he was diagnosed as periocular cellulitis at another hospital. After taking antibacterial medication, the patient did not improve. Head MRI revealed sinusitis and a left-sided subdural abscess. Antimicrobial therapy, steroid therapy, and immunoglobulin therapy were started, but the patient developed paralysis of the right lower extremity and was transferred to our hospital on the 20th day of onset. At the time of transfer, right upper and lower extremity motor paralysis, myoclonic seizures of the right lower extremity, disorientation, and tonic-clonic convulsions were observed. As the subdural abscess was not encapsulated and drainage of the abscess was difficult, only sinus drainage was performed. Propionibacterium acnes was detected in the sinuses. Brain MRI showed encephalitis in the left frontal lobe, and multidisciplinary treatment, including antibacterial therapy and steroid pulse therapy, was performed. Later, the abscess enlarged and formed a capsule over the entire subdural region of the left cerebral hemisphere; thus, neuroendoscopic drainage was performed on the 44th day of onset. Postoperatively, the patient's associated symptoms improved. The patient was discharged from the hospital without neurological symptoms on the 80th day of onset after continued administration of antimicrobial agents. Two and a half years later he had no recurrence and was without neurological sequelae, including higher functional impairment. Neuroendoscopy (soft speculum) can provide effective drainage and may contribute to prognosis.
