Roxana Nartea, Monica Hodor, Simona Vetu, Ilinca Pirciog
Subdural empyema is a rare but life-threatening intracranial infection, most commonly arising as a complication of paranasal sinusitis. Early diagnosis and multidisciplinary treatment are essential to reduce morbidity and mortality. A 23-year-old previously healthy male developed a rapidly progressive subdural empyema associated with superior sagittal sinus thrombosis and severe sepsis. Clinical deterioration occurred within 24 hours of symptom onset. Cranial computed tomography revealed a left fronto-temporo-parietal subdural collection with mixed density and air inclusions, along with extensive pansinusitis. Emergency neurosurgical evacuation was followed by otorhinolaryngological surgical management. Broad-spectrum intravenous antibiotics and anticoagulation therapy were administered under intensive care monitoring. Microbiological analysis identified Prevotella oris. Postoperatively, the patient required structured neurorehabilitation for right-sided hemiparesis and mixed aphasia, achieving gradual functional recovery. Gradual neurological and functional improvement was observed during the follow-up period. This case highlights the importance of early diagnosis, prompt multidisciplinary management, and comprehensive rehabilitation in improving outcomes. Although a favorable recovery was achieved, conclusions regarding causality and treatment efficacy are limited by the single-case design.