WHEN ONE ISNT ENOUGH: A CLINICAL CASE OF MULTIPLE TUBERCULOUS SUBDURAL EMPYEMAS

Introduction: Empyema is, by definition, an encapsulated purulent mass within the subdural space, distorting the underlying cortex and causing discrete neurological symptoms based on its position and volume. This condition is uncommon, particularly when it is situated interhemispherically. Diagnosis is chiefly based on imaging studies along with the infectious disease evaluation. Tuberculous empyema is the least frequently described form of neuro-meningeal tuberculosis. Prompt surgical intervention coupled with targeted long term antimicrobial therapy is required to ensure complete eradication of the pathogen while preventing potentially life-threatening complications.

case report:We report the case of a 76-year-old female patient who initially presented with intractable headaches accompanied by nausea and vomiting. Her condition worsened with the onset of dysarthria and right-sided facial weakness, followed by a generalized tonic-clonic seizure.A cerebral CT scan revealed multiple hypodense subdural collections with peripheral enhancement. Surgical drainage via burr hole evacuation was performed for the largest collection, and PCR testing confirmed Mycobacterium tuberculosis. Anti-tubercular therapy was initiated and maintained for 9 months, with favorable clinical and radiological outcomes.