This young patient initially presented with fever, headache, nasal discharge and congestion. Sinusitis affecting the frontal, right maxillary, sphenoidal and ethmoidal sinuses was confirmed on CT scan. He was treated with antibiotics and nasal decongestant spray with clinical improvement and was subsequently discharged. He re-presented two weeks later with a seizure and acute onset left hemiparesis. A CT brain revealed an extensive right supratentorial subdural empyema with mass effect. An urgent neurosurgical review was obtained and the patient underwent surgical drainage of the subdural empyema.

Subdural empyema is a rare intracranial complication of frontal sinusitis ¹. This case highlights the importance of early recognition and treatment of this potentially fatal condition.