Successful surgical management of an Escherichia coli epidural-subdural abscess secondary to sino-rhinotomy.

OBJECTIVE: To describe a case of successful management of epidural-subdural abscess and severe meningitis with secondary brain herniation in a dog. CASE SUMMARY: A rhino-sinusotomy was performed in a 3-year-old mixed-breed dog for management of refractory sinonasal aspergillosis. Initial recovery was good, but the dog became acutely stuporous 36 hours after surgery. Evidence of increased intracranial pressure with brain herniation and midline shift secondary to an epidural abscess was observed on magnetic resonance imaging. Decompressive craniectomy and drainage of the abscess was performed. Intensive nursing care and physiologic support was performed with consciousness returning 7 days after initial stupor. The dog was discharged 14 days after craniectomy and was ambulatory with support. NEW/UNIQUE INFORMATION PROVIDED: Intracranial abscesses are rarely described in dogs and few had a successful outcome reported. All previous reports have been of brain abscesses or empyema, rather than a combination of epidural and subdural abscessation. Additionally, the process of sino-rhinotomy for management of aspergillosis has not been previously linked to intracranial abscess formation. To the authors' knowledge, this is the first report of successful management of an epidural-subdural abscess and suggests that even with cases with low modified Glasgow Coma Scale scores outcome may be positive.

Successful medical management of a domestic longhair cat with subdural intracranial empyema and multifocal pneumonia.

OBJECTIVE: To describe a case of successful medical management of subdural intracranial empyema and multifocal pneumonia in a domestic longhaired cat. CASE SUMMARY: A 7-year-and-8-month-old male neutered domestic longhair cat presented with tachypnea, respiratory compromise, vestibular ataxia, obtundation, left-sided head tilt, and multiple cranial nerve deficits. Neuroanatomical localization was multifocal with central vestibular involvement. Magnetic resonance imaging of the head indicated diffuse subdural empyema, mainly affecting the middle cranial fossa and the right cerebrum. Analysis of cerebrospinal fluid revealed degenerate neutrophils with a mixed population of intracellular bacilli. Computed tomography (CT) of the thorax was suggestive for multifocal pneumonia. Aggressive medical management with IV fluids, oxygen supplementation, mannitol boluses, dexamethasone, and broad-spectrum antimicrobials was initiated. The cat demonstrated gradual improvement within 24 hours following initiation of treatment. General physical and neurological examinations, 9 weeks after initiating treatment, did not reveal any abnormalities. A CT examination performed at this time revealed resolution of the cat's pulmonary lesions. The cat was still free of clinical signs, 9 months after treatment was started. NEW OR UNIQUE INFORMATION PROVIDED: Subdural empyema is infrequently reported in cats and has high mortality rates even following surgical treatment. To the authors' knowledge, this is the first reported case of successful medical management of a cat with subdural empyema and suggests that aggressive medical management should be attempted in cats that are not considered surgical candidates.

Presumptive subdural empyema in a dog.

A 13 mo old mixed-breed dog was referred for acute lateralized forebrain signs. MRI of the brain demonstrated abnormalities consistent with severe meningitis and subdural empyema secondary to a retrobulbar abscess. The dog's clinical signs improved with antibiotic therapy, and repeat imaging showed resolution of subdural fluid accumulation presumed to be empyema with mild residual meningeal enhancement. Subdural empyema is an infrequent cause of encephalopathy in small animals and usually develops through direct extension of a pericranial infection. This report presents a case of presumptive subdural empyema in a dog that was successfully treated without surgical intervention. MRI is the preferred imaging modality for diagnosis of subdural empyema, and the characteristic imaging features are described.

Intracranial empyema: literature review and two novel cases in cats.

OBJECTIVES: To review the literature on intracranial empyema and report two new cases in cats. METHODS: Literature review and case reports. RESULTS: Intracranial empyema has been rarely reported in small animals. In two novel cases in cats, the route of infection was postulated to be local extension from a retrobulbar abscess of odontogenic origin in one case and direct inoculation from a penetrating bite wound to the skull, confirmed at post-mortem examination, in the other. On magnetic resonance imaging of the first case, there was a contrast-enhancing large extra-axial fluid collection overlying the right cerebral hemisphere, consistent with subdural empyema. Infection was caused by an Actinomyces spp. This is the first report of successful treatment of intracranial empyema by craniotomy, drainage and antibiotics. CLINICAL SIGNIFICANCE: Intracranial empyema is a neurosurgical emergency. Favourable outcomes may be achieved with surgical decompression, antimicrobial therapy and intensive care.