IADR Abstract Archives
Bilateral Subdural Empyema of Dental Origin:a Case Report and Review of Literature
Objectives: Intracranial empyema is a life threatening suppurative infection of the brain developing between the dura mater and the arachnoid membrane. The purpose of this work was to report a case of a bilateral cranial subdural empyema of odontogenic origin and to conduct a literature review.
Methods: The patient, a 38 year old woman with a history of recent painful dental treatments was referred from the infectious disease department for the investigation of dental oral infectious foci at the origin of a bilateral subdural empyema. Information regarding patient’s medical history and treatment were recorded. Clinical and radiological examinations were performed as well.A literature review was carried out through a search of MEDLINE using appropriate keywords and criteria.
Results: The extra oral examination showed a slight right submandibular asymmetry associated with a painful lymphadenopathy. The intraoral examination displayed multiple restorations on molars (16,17,18,27,48 ) and periapical lesions shown on the dentascan. As the patient was already under intravenous poly-antibotherapy ,all infected teeth were removed. No surgical cranial drainage was indicated. Antibiotic therapy was changed 18 days later due to an allergic reaction. The patient had a favorable outcome with the resolution of the lesion seen on the CT scan 4 months later. The ten case reports collected from the literature showed that symptoms were marked by fever, swelling, severe headache and neurological deficit .Tooth extraction and apical periodontitis were the most common dental origins. In all cases intravenous antibiotherapy associated to a cranial surgical drainage were performed. The outcome was favorable in most cases.
Conclusions: Although,the present case is similar to the reported data of the literature, the location of the brain empyema is bilateral . The dentist should carefully conduct oral examination and treatments to prevent such a life-threatening condition.
Methods: The patient, a 38 year old woman with a history of recent painful dental treatments was referred from the infectious disease department for the investigation of dental oral infectious foci at the origin of a bilateral subdural empyema. Information regarding patient’s medical history and treatment were recorded. Clinical and radiological examinations were performed as well.A literature review was carried out through a search of MEDLINE using appropriate keywords and criteria.
Results: The extra oral examination showed a slight right submandibular asymmetry associated with a painful lymphadenopathy. The intraoral examination displayed multiple restorations on molars (16,17,18,27,48 ) and periapical lesions shown on the dentascan. As the patient was already under intravenous poly-antibotherapy ,all infected teeth were removed. No surgical cranial drainage was indicated. Antibiotic therapy was changed 18 days later due to an allergic reaction. The patient had a favorable outcome with the resolution of the lesion seen on the CT scan 4 months later. The ten case reports collected from the literature showed that symptoms were marked by fever, swelling, severe headache and neurological deficit .Tooth extraction and apical periodontitis were the most common dental origins. In all cases intravenous antibiotherapy associated to a cranial surgical drainage were performed. The outcome was favorable in most cases.
Conclusions: Although,the present case is similar to the reported data of the literature, the location of the brain empyema is bilateral . The dentist should carefully conduct oral examination and treatments to prevent such a life-threatening condition.