Summary

Objective: To describe a very complicated case of sinusitis, the subdural empyema, a rare disease present not only in children, in which most cases leave sequels, coursing a high emotional, social and economic impact, because of the constant need for rehabilitation.

Description: Patient FBDM entered the HUAV Pediatrics emergency room, in Alfenas, complaining of vertigo, diplopia, articular pain, nausea, holocranial progressive headache for 2 days. At the examination the patient presented an average physical condition, with pallor (+/4+),normal hydration, isophotoreacting pupils, presenting posterior rhinorrhea, rigid neck, with a temperature of 36,8oC, in the first 12 hours following a course with an episode of convulsive crisis, aggravation of the cephalea and palpebral ptosis. A computized tomoghaphy of the brain showed a left subdural empyema. A triple antibiotic therapy was initiated (vancomycin + ceftriaxone + metronidazol), and surgery for drainage was performed. On the 38TH day the patient was discharged, presenting dysphagia with progressive improvement, and was told to return for frequent medical visits. Today no sequels are present and the patient is being followed by a neurologist and an otorhinolaryngologist.

Discussion: Complication of acute and chronic sinusitis is defined as any extension of the local disease to adjacent structures. All acute and chronic sinusites may lead to intracranial complications. The empyema in this patient was located in only one side, but in further studies it is described as presenting in multiple locations. For many authors the risk of sequels is very high, although not in this case. Attention is called to the importance of having an antifungal coverage, due to the various agents present in our flora.