Epidural Empyema Caused By Frontal Sinus Aspergillosis

Aspergillosis infection located primarily in the frontal sinus and invading into the dura is rare. A 74-year-old male patient was admitted with headache of 3-month duration that did not respond to analgesics. Cranial MRI showed an irregular hyperintense lesion in T2 FLAIR and T1 FLAIR, arising from the right frontal sinus and advancing to the intracranial space. A collection, hyperintense on T2 FLAIR and isointense on T1 FLAIR, adjacent to the left frontal sinus was observed, consistent with epidural empyema. The lesions were drained surgically, and subsequently treated with antifungal therapy using Amphotericin B. The headache resolved completely after surgical drainage. The patient has been followed-up for a year and is currently asymptomatic. Aspergillosis infections lodging primarily in the frontal sinus and spreading to the dura are very rare, therefore, we report this case in the present paper. (Arc-hi-ves of Neu-ropsy-chi-atry 2012;49: 83-5)