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Resume Introduction Les suppurations intracrâniennes (SIC) sont mal evaluees en Afrique subsaharienne, particulierement chez l’enfant. Patients et methodes Etude retrospective du 1 er janvier 1996 au 31 decembre 2004 chez les enfants admis pour SIC secondaire a une infection otorhinolaryngologique (ORL) a l’hopital Principal de Dakar, Senegal. Seuls ont ete inclus les cas confirmes par tomodensitometrie (TDM). Resultats Seize enfants (12 garcons et 4 filles) d’âge moyen de 11,2 ans (extremes : 7–15 ans), ont ete admis pour SIC en moyenne 12 j (extremes : 1–60 j) apres le debut de la fievre et 6 j (extremes : 1–22 j) apres celui des signes neurologiques. La fievre etait presente 14 fois et les signes neurologiques etaient constants. L’infection initiale etait une sinusite ( n = 14) ou une otite ( n = 2). La SIC etait un empyeme sous-dural ( n = 8), un abces cerebral unique ( n = 6) ou multiple ( n = 1), ou l’association empyeme sous-dural et abces cerebral ( n = 1). L’analyse bacteriologique etait rarement contributive : Staphylococcus aureus ( n = 2), streptocoque non groupable ( n = 2), et association Pseudomonas aeruginosa – Proteus mirabilis ( n = 1). L’antibiotherapie, associee 4 fois a des corticoides et 9 fois au phenobarbital, etait prescrite pendant 2 mois. Une ponction de la SIC a ete pratiquee chez 13 patients. Tous les enfants ont gueri, mais 4 ont garde des sequelles neurologiques. Discussion Cette serie permet de preciser les caracteristiques des SIC chez l’enfant en Afrique subsaharienne et de proposer un protocole therapeutique adapte a ce contexte. Conclusion L’acces a la TDM a ete primordial pour guider la prise en charge medicochirurgicale et permettre une issue le plus souvent favorable, malgre un diagnostic tardif.

Intracranial suppurations (ICSs) are poorly assessed in sub-Saharan Africa, especially in children.A retrospective study from 1st January 1996 to 31st December 2004 in children admitted to the pediatric department of the Hôpital Principal de Dakar, Senegal, for a sinogenic or otitic ICS. All cases were diagnosed by CT scan.Sixteen children (12 boys and 4 girls), mean age of 11.2 years (range, 7-15 years), were admitted with the primary diagnosis of ICS. The mean time from the beginning of fever or neurological disorders to admission was 12 days (range, 1-60 days) and 6 days (range, 1-22 days), respectively. At admission, fever was noted in 14 patients and neurological signs in all patients. Otolaryngologic infections were sinusitis (n=14) or otitis (n=2). ICSs were subdural empyema (n=8), single (n=6) or multiple (n=1) cerebral abscesses, or association of subdural empyema and cerebral abscess (n=1). Bacteriological cultures were seldom positive because of frequent previous antibiotic therapies and showed Staphylococcus aureus (n=2), nongroupable Streptococcus (n=1), or Pseudomonas aeruginosa and Proteus mirabilis (n=1). Antibiotics were given initially intravenously for 30 days, then orally for 30 days. Additionally, some patients received corticosteroids (n=4) or phenobarbitone (n=9). Aspiration drainage of the ICS was undertaken in 13 patients. All the children were cured, 4 of whom had neurological sequelae at follow-up.This pediatric series provides important data on the characteristics of ICS in sub-Saharan Africa. Therapeutic measures adapted to this context are proposed.Access to CT scan was fundamental in guiding medical and surgical management and ensuring a mostly favorable outcome despite long delays in treatment initiation.