Surg Neurol
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Subdural empyema is a known yet infrequent complication of bacterial meningitis. Subdural effusions occur frequently with meningitis in children and usually resolve spontaneously or with subdural taps. Subdural empyema should be suspected when a patient fails to respond to antibiotic therapy or worsens neurologically. ⋯ We present a case of subdural empyema complicating bacterial meningitis in a 4 month old in which CT enhancement was not present yet magnetic resonance imaging (MRI) scans with gadolinium demonstrated intense enhancement. For comparison, we present a second case of a child with sterile subdural effusions due to meningitis that demonstrates an absence of contrast enhancement on MRI studies. MRI scans with contrast may offer a more sensitive means of making an early diagnosis of subdural empyema.