COVID-19 infection and extensive subdural empyema: cause or consequence?


  • Aldo Jose Ferreira da Silva Neurocirurgia Pediátrica do Hospital Geral do Estado e da Divisão de Neurocirurgia Pediátrica da Maternidade Escola Santa Mônica - Universidade Estadual de Ciências da Saúde de Alagoas, Maceió, Alagoas, Brasil (Pediatric Neurosurgery, General State Hospital and at the Pediatric Neurosurgery Division of the Santa Mônica Teaching Maternity - Alagoas State University of Health Sciences, Maceió, Alagoas, Brazil)
  • Daniel Fonseca Oliveira Neurocirurgia Pediátrica, Hospital Geral do Estado, Maceió, Alagoas, Brasil (Pediatric Neurosurgery, General State Hospital, Maceió, Alagoas, Brazil)



Empyema, COVID-19, infection, tomography, decompressive craniectomy


Adolescent, female, 12 years old, with a history of headache and vomiting, without fever, with progressive worsening and coma. Laboratory tests showed positive SARS-CoV-2 PCR RNA. She has not had the vaccine for COVID-19. A non-contrast-enhanced cranial tomography(Figure 1a) showed a right fronto-temporo-parietal cortical hypodense area with significant midline shift. A decompressive craniectomy was performed with drainage of extensive subdural empyema(Figure 1c).

Subdural empyema is most often a consequence of paranasal sinus infections. With the COVID-19 virus also located in the paranasal sinuses, it is not possible to determine whether it is a consequence or cause of subdural empyema (1). Although the pathophysiology is unclear, it is possible that upper respiratory infection by COVID-19 creates a favorable environment for bacterial sinusitis coinfection(Figure 1b), intracranial extension, and formation of subdural empyema (2). Another possible explanation is that the SARS-CoV-2 virus infection affects the immune system and makes the individual more susceptible to infection (3). Therefore, more studies are needed to clarify the relationship between SARS-CoV-2 infection and other infections.


Figure Caption

Figure 1 (a) Computed tomography of the skull, with the axial section showing a right fronto-temporo-parietal hypodense area(black arrows) with significant midline shift(black arrowheads). (b) Computed tomography of the skull, with the coronal section showing signs of sinusitis with opacification of the right ethmoid sinus(black arrow). (c) Intraoperative view after opening the dura mater showing exposure of the right fronto-temporo-parietal cortex covered by viscous purulent secretion(black arrow). (d)  Computed tomography of the skull, with the coronal section showing after treatment without ethmoid opacification(black arrow) and small postoperative CSF collection(black arrowhead).


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- Haroon K, Reza MA, Taher T, Alam MS, Haque RU, Ahmed MF & Hossain SS. Acute subdural empyema in the young COVID-19 patient- A case report. Bangladesh Journal of Neurosurgery. 2021;10(2):206–209. DOI: 10.3329/bjns.v10i2.53776

- Ljubimov VA, Babadjouni R, Ha J, et al. Adolescent subdural empyema in setting of COVID-19 infection: illustrative case. Journal of Neurosurgery: Case Lessons. 2022; 3(4):CASE21506. DOI: 10.3171/CASE21506

- Charlton M, Nair R, Gupta N. Subdural empyema in adult with recent SARS-CoV-2 positivity case report. Radiol Case Rep. 2021; 16(12):3659-3661. DOI: 10.1016/j.radcr.2021.09.010

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How to Cite

da Silva AJF, Oliveira DF. COVID-19 infection and extensive subdural empyema: cause or consequence? . Arch Pediatr Neurosurg [Internet]. 2023 Mar. 20 [cited 2024 May 24];5(2):e1752023. Available from: