Bilateral epidural empyemas in an adolescent.

Epidural empyema is an unusual cause of headache that may be encountered in the emergency department. The collection of suppurative fluid usually results from local spread of sinusitis, although many other predisposing factors have also been described. Patients with epidural empyema usually present with nonspecific cephalalgia that may be accompanied by fever and leukocytosis but is unlikely to be associated with focal neurological findings. The case of an adolescent who presented to our emergency department twice in 6 days with persistent headache is reported; cranial computed tomography performed on the second visit demonstrated bilateral epidural empyema. This entity is uncommon, but may certainly be encountered by the emergency physician.