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The Intracranial Complications of infection of the paranasal sinuses are uncommon and subdural empyema is rarer still. Roughly half of the cases of subdural empyema are caused by sinusitis and the most common source of infection is the frontal sinuses. MR scan is the method of choice for the diagnosis and monitoring of subdural empyema, allowing prompt institution of appropriate treatment thereby reducing mortality. We describe a 15-year-old girl with interhemispheric subdural empyema caused by fronto-ethmoidal sinusitis. Clinical onset was characterised by high fever, severe headache, nausea, vomiting and diplopia. CT scan showed evidence of a left parafalcial hypodense collection. MR scan, especially after contrast administration, showed the exact extension and location of the interhemispheric subdural empyema, also displaying the associated leptomeningitis and fronto-ethmoidal sinusitis. Prompt medical treatment led to a remission of symptoms and sinus infection with associated leptomeningitis as documented by serial MR monitoring. However, the slow progressive increase in size of the subdural collection was deemed an indication for neurosurgical management (evacuation of the collection by ventricular drainage catheters inserted under stereotaxic control) leading to a complete resolution of the subdural empyema without neurological sequelae.

Aim of our study is to present the findings of parietal cortex alterations in patients affected by movement disorders. We observed 4 patients with movement disorders (3 parkinsonian syndromes, I diffuse dystonia) and MR evidence of cortical alterations, without additional cerebral lesions. MR was performed with a 0.5T unit, SE T1-w, TSE T2-w, and Turbo Fluid Attenuated Inversion Recovery (T-FLAIR) sequences on axial and coronal planes, contiguous slices and 5 mm slice thickness. In the parkinsonian patients, parietal atrophy was observed in 2 cases and fronto-parietal atrophy in I case; in all cases T-FLAIR sequences showed bilateral parietal cortex signal alteration. The patient with diffuse dystonia presented severe bilateral parietal atrophy with bilateral fronto-parietal signal alteration. Our findings are strongly suggestive for cortico-basal degeneration. The evidence of signal alteration within the cortex suggests a primary pathogenetic involvement of cortico-basal pathways.