Rapidly Developing Subdural Empyema in an Adult with Sinusitis- A Neurosurgical Threat Alert!

Sinonasal inflammatory disorders usually have an innocuous clinical course; however, rarely they can affect the orbits, underlying bones, adjacent veins and the intracranial structures. Intracranial extension is the most dangerous complication of these disorders. The commonest form of intracranial involvement is subdural empyema with bacterial sinusitis being its leading cause. We present a rare case of rhinosinusitis that, within a few hours progressed into a large subdural empyema with severe mass effect and midline shift. The case highlights the importance of having a high index of clinical suspicion and low threshold for imaging in cases of sinusitis that present with subtle neurological signs and symptoms. We emphasize on the role of imaging in optimal management of these cases. The imaging helps in identification of catastrophic neurological complications early in the course of disease and thus guides the treatment approach.