Intracranial tuberculous
subdural empyema (
ITSE) is extremely rare. To our knowledge, only four cases of microbiologically confirmed
ITSE have been reported in the English literature to date. Most cases have arisen in patients with
pulmonary tuberculosis regardless of
trauma. A 46-year-old man presented to the emergency department after a fall. On arrival, he complained of
pain in his head, face, chest and left arm. He was alert and oriented. An initial neurological examination was normal. Radiologic evaluation revealed
multiple fractures of his skull, ribs, left scapula and radius. Though he had suffered extensive
skull fractures of his cranium, maxilla, zygoma and orbital wall, the sustained
cerebral contusion and
hemorrhage were mild. Eighteen days later, he suddenly experienced a general tonic-clonic seizure. Radiologic evaluation revealed a
subdural empyema in the left occipital area that was not present on admission. We performed a
craniotomy, and the
empyema was completely removed. Microbiological examination identified Mycobacterium tuberculosis (M.
tuberculosis). After eighteen months of anti-tuberculous treatment, the
empyema disappeared completely. This case demonstrates that
tuberculosis can induce
empyema in patients with
skull fractures. Thus, we recommend that M.
tuberculosis should be considered as the probable pathogen in cases with posttraumatic
empyema.