Un hématome sous-dural qui n'en est pas un chez une femme âgée

A 79-year-old woman was admitted for a fall, cough, transitory loss of consciousness and right hemiparesis and was diagnosed as exhibiting community acquired pneumonia, pulmonary embolism and possible first seizure. The brain CT scan was normal and the evolution was satisfactory under antibiotics and anticoagulants. After three weeks, the woman was rehospitalised for motor aphasia without fever. The MRI showed signs of acute subdural hematoma (SDH) with peripheral oedema and the anticoagulants were stopped. One week after the women was readmitted for gait and right upper limb proprioceptive disorders. Brain CT scan showed an increase in the oedema around the SDH and a short corticotherapy was initiated. One week later, motor aphasia appeared and consciousness disorders. The MRI was in favour of a subdural empyema. Copious pus in addition to the SDH was evacuated by emergency drainage. Haemophilus aphrophilus and Peptostreptococcus micros were identified from bacterial cultures. Appropriate antibiotics led to complete recovery. Practitioners have to be aware that subdural empyema, which is a rare and severe condition in the case of delayed diagnosis, can present in older subjects as a subacute neurological disorder mimicking an HSD, frequently observed in this population.