Sinogenic subdural empyema and Streptococcus anginosus

Subdural empyema (SDE) is most commonly caused by sinusitis and, without ea rly diagnosis and neurosurgical intervention, is associated with high morta lity. In a patient with sinusitis who presents with mental status changes, the diagnosis of SDE should be suspected on clinical grounds, even in the a bsence of significant computed tomographic findings. Computed tomography wi th contrast is a useful aid in the diagnosis of SDE, but findings may be su btle, and contrasted magnetic resonance imaging is superior. The associatio n of Streptococcus anginosus sinusitis and related intracranial sequelae is important owing to the potentially catastrophic complications and should b e recognized by otolaryngologists. In view of the rapidly progressing natur e of sinogenic SDE, physicians should strongly consider early institution o f aggressive therapy consisting of craniotomy with concurrent sinus drainag e in patients in whom sinogenic SDE is suspected on clinical grounds, parti cularly in the presence of S anginosus-positive sinus cultures.