P1.005: Cerebrovascular Vasospasms, Cerebral Sinus Venous Thrombosis, and Rapid Empyema Reaccumulation in a Child with a Co-Infection of Fusobacterium nucleatum and Prevotella loescheii

Introduction: Fusobacterium nucleatum and Prevotella loescheii are anaerobic gram-negative rods that exist in the oral cavity. To our knowledge, pediatric central nervous system complications with these pathogens have not been well described.

Case Description: An 11-year-old previously healthy vaccinated female presented for 2 weeks of sinusitis which progressed to left arm and leg hemiplegia. Initial neuroimaging demonstrated a superior sagittal sinus thrombosis and a right hemispheric subdural empyema with midline shift, necessitating surgical evacuation. Gram staining of the subdural accumulation demonstrated co-infection of Fusobacterium nucleatum and Prevotella loescheii. Within 24 hours of evacuation, the patient progressed to have right hemispheric electrographic status epilepticus (ESE), with neuroimaging demonstrating reaccumulation of the empyema and a moderate right middle cerebral artery (MCA) vasospasm. Transcranial doppler ultrasound of the right MCA territory demonstrated mean flow velocities up to 148 cm/sec with a Lindengaard ratio of 3.44. The patient underwent repeat subdural evacuation and was managed with intravenous fluids, permissive hypertension, oral nimodipine, and intravenous milrinone. ESE was treated with intravenous Lacosamide and and Levetiracetam. Repeat neuroimaging demonstrated improvement in subdural collection size and resolution of vasospasms. She was discharged after 16 days with continued Lacosamide and Levetiracetam for seizures, and Lovenox for the superior sagittal sinus thrombosis.

Discussion: We present a novel pediatric case of Fusobacterium nucleatum and Prevotella loescheii manifesting with rapid subdural empyema reaccumulation after surgical evacuation, status epilepticus, cerebrovascular vasospasms and cerebral sinus venous thrombosis.

Conclusion: Further work is needed to understand the potential neurologic complications of this condition.