A teenage girl woke up one day with a swollen red eye. She had a bout of flu, cough and catarrh the previous week. The cold was almost all gone when this new problem started. So, off she went to the ophthalmologist who diagnosed an eye infection and started antibiotics. It did not get better and she was taken to see another ophthalmologist for a second opinion.
By this time, the forehead was involved, her head hurt and she had a fever. The ophthalmologist recognised that this was not just a simple eye infection and referred her for neurological evaluation, admission and care. This turned out to be the life saving decision because shortly afterwards, she stopped talking and went into coma. An urgent brain scan revealed that she had infection of the eye and the sinuses extending through the bone into the brain. The brain was swollen and under pressure due to large amount of pus from the infection.
This condition is called an acute subdural empyema. It means pus on the brain and could lead to seizures, stroke, coma and death if not properly treated. Early recognition and effective treatment with surgery and antibiotics save lives. Delay could lead to permanent injury, disability and death.
In view of the seriousness of the condition and the fact that she was already in coma, there was little option but to operate. The operation entailed removing the bone over the forehead and washing out the pus on the brain and in the sinuses. We also washed everything in antibiotics and then put it all back together again. Thereafter, she continued on serious antibiotics for 3 months to ensure that the germs were killed permanently.
How a little infection can kill you?
Infections like this can lead to what we call sepsis. Sepsis is an extremely serious condition, due to an overwhelming reaction of the body to infection. The infection causes the body to release chemicals as a defence mechanism. However, the chemicals themselves can cause widespread inflammation, which can then damage the body organs.
In the worst cases, the infection leads to a life-threatening drop in blood pressure, called septic shock. This can quickly lead to the failure of several organs including the lungs, liver and kidney, causing death.
Common symptoms and signs of sepsis
Some of the symptoms include:
- High temperature
• Low blood pressure
• Confusion and sickness
• Lightheaded and coma
Who can get it?
Anyone can get sepsis. A minor cut, scrape or a bug bite that was ignored can set off the deadly cascade. In the case of this teenager, a sinus infection that was treated as a simple catarrh resulted in pus collecting in her brain.
Why is it so dangerous?
• Every hour raises the risk of death by 8% if the sepsis is untreated
• At least 50% of septic shock patients do not survive
• Vital to get treated as soon as possible
Dr Biodun Ogungbo, Consultant Neurosurgeon in Abuja is a UK General Medical Council Registered Specialist in Neurosurgery and Nigerian Medical and Dental Council registered Surgeon. He has extensive surgical repertoire in elective and emergency surgery. He supports medical education and is active in health advocacy. He is interested in stroke and spine problems and has written extensively about these conditions.