Neurosurgery
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The case of a patient who suffered a nontraumatic subarachnoid hemorrhage (SAH) associated with normal angiography is reported. Three weeks later he developed an embolic stroke secondary to a nonhemolytic Staphylococcus epidermidis endocarditis of the mitral valve; thus, the SAH was the initial manifestation of bacterial endocarditis. Bacterial endocarditis should be considered a possible cause of SAH, especially in the 7% of patients with angiographically negative SAH.
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Because subdural empyema (SDE) is an unusual central nervous system infection, recognition is not always prompt. Consequently delays can allow a serious but curable infection to become irreparably damaging or even fatal. This condition, particularly in the early stages, is relatively easy to treat. ⋯ Although the findings of definitive diagnostic studies (computed tomography or angiography) are strikingly positive in advanced cases, in the earlier stages of this disorder they may be subtly abnormal. Because the mortality and morbidity rates, in some measure, depend on the stage at which the process is arrested, the real challenge lies in making a prompt diagnosis. The most favorable results are associated with early, decisive surgical treatment.