Subdural empyema complicating meningitis is relatively common in infants, but is rare in adults. Further infratentorial subdural empyema represents only a small portion of all cases of subdural empyema. The overwhelming majority of infratentorial empyema cases follow a neglected otogenic sepsis, trauma or paranasal sinusitis. We describe a case of 26 years old male who was diagnosed as pyogenic meningitis and developed infratentorial subdural empyema without any evidence of otogenic infection, trauma or sinusitis. The patient was successfully treated with prolonged course of antibiotics without the need for surgical intervention. The infratentorial subdural empyema is a rare entity and its occurrence without any predisposing factor or trauma makes it rarer. Secondly, the primary modality of treatment of subdural empyema is surgical but the present case was treated without any surgical intervention making it further an unusual case. We wish to highlight that subdural empyema should be considered even in adult patients with suspected or proven bacterial meningitis who develop progressive deterioration in sensorium or focal neurological signs even without predisposing co-morbidities.
Key words: Meningitis, subdural empyema, infratentorial subdural empyema.
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