• Angelo Pompucci, Pasquale De Bonis, Giovanni Sabatino, Giovanni Federico, Massimo Moschini, Carmelo Anile, and Annunziato Mangiola.
• Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy.
• J Neuroimaging. 2007 Oct 1;17(4):358-60.

Background And PurposeSubdural empyema represents a loculated infection between the dura and the arachnoid. It has been described either intracranially or in the spinal canal, the latter localization being quite rare. While treatment guidelines for a single (either brain or spinal) localization of a subdural empyema are more or less established, its management when a massive involvement of CNS is evident represents a challenge.MethodsThe authors describe a unique case of a 65-year-old woman having a massive involvement of the entire CNS with multiple localizations, both intracranial and spinal. Early diagnosis was obtained through brain CT scans followed by cranio-spinal contrast enhanced MRI scans. Patient was treated with external ventricular drainage and suboccipital craniectomy, while on antibiotic therapy.ResultsPatient's neurological condition gradually improved. By the end of the eighth hospital week, she was discharged without any neurological deficit.ConclusionsSpinal subdural empyema and brain subdural empyema are not always, as in our case, two different entities. Prompt diagnosis and treatment constitute the major variables affecting outcome.

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