Child's Nervous System

, Volume 35, Issue 4, pp 719–723 | Cite as

Treatment-refractory Escherichia coli subdural empyema caused by infection of a chronic subdural hematoma in an infant

  • Jason A. Chen
  • Dimitrios Mathios
  • Joaquin Hidalgo
  • Alan R. CohenEmail author
Case Report



Subdural empyema (SDE) is a neurosurgical emergency that is typically treated with surgical drainage, either by burr hole or by craniotomy. Escherichia coli is an uncommon cause of SDE and is associated with infection of a pre-existing subdural hematoma.

Case report

We report the case of an otherwise healthy, immunocompetent 4-month-old infant girl with an E. coli-infected subdural hematoma. The infection persisted despite aggressive neurosurgical treatment that included drainage of the subdural space through burr holes and, subsequently, a wide craniotomy was performed. Ultimately, after 30 days, the SDE resolved with good neurological outcome. A review of prior literature indicates that infected subdural hematomas (including those caused by E. coli) are typically less aggressive and respond to burr hole drainage.


We illustrate the fulminant progression of the SDE in the face of neurosurgical treatment. Our experience suggests lowering the threshold for wide craniotomy in these incompletely understood cases.


Subdural empyema Subdural hematoma Intracranial abscess Escherichia coli 


Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryDavid Geffen School of Medicine, UCLALos AngelesUSA
  2. 2.Division of Pediatric Neurosurgery, Department of NeurosurgeryThe Johns Hopkins University School of MedicineBaltimoreUSA

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