Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

Transformation from chronic subdural hematoma into subdural empyema following cat bites: a case report

Takuya Konno, M.D., Ph.D.1), Kei Yamada, M.D.1), Sou Kasahara, M.D.1), Yoshitaka Umeda, M.D.1), Mutsuo Oyake, M.D., Ph.D.1) and Nobuya Fujita, M.D., Ph.D.1)

1)Department of Neurology, Nagaoka Red Cross Hospital

A 69-year-old man developed motor aphasia and right hemiparesis with severe headache, during the treatment of cellulitis and sepsis due to cat bites. Brain CT showed a low density, crescent-shaped lesion in the left subdural space, which was hypointense on brain diffusion-weighted imaging (DWI). One week later, when his neurological symptoms had worsened, the signal of the subdural lesion had changed to hyperintense on DWI. The lesion was capsule-shaped when enhanced by Gadolinium. The signal changes on DWI of the lesion indicated the existing hematoma had changed to an empyema, or so-called infected subdural hematoma, due to a hematogenous bacterial infection. Pasteurella multocida, a resident microbe in the oral cavity of cats, could be the responsible pathogen in this case. The patient recovered completely after treatment with intravenous high dose antibiotics. This is an important case report describing the transformation from a chronic subdural hematoma into a subdural empyema by DWI.
Full Text of this Article in Japanese PDF (505K)

(CLINICA NEUROL, 55: 657|660, 2015)
key words: infected subdural hematoma, subdural empyema, chronic subdural hematoma, cat bites, Pasteurella multocida

(Received: 19-Feb-15)