OBJECTIVE: The objective of this paper is to evidence that there are no viral or bacterial complications from acute rhinosinusitis, which is an inflammatory process that affects the mucosal lining of the paranasal sinus for up to 4 weeks and is caused by gram-positive cocci or anaerobes. The diagnosis is not easy, which explains the genesis of this study. Clinical Case: A 14-year-old Caucasian male came to the emergency room of Nossa Senhora da Conceição Hospital with a history of holocranial headache that started 1 day prior and was associated with fever, vomiting, and edema of the right hemiface. A cranial CT showed fronto-ethmoid and maxillary acute sinusitis. A puncture showed liquor that was a little cloudy. Subdural drainage of empyema is an urgent surgical procedure. The patient was admitted to the intensive care unit, where antibiotics were started. His condition evolved with anisocoria and persistent fever, and a control cranial CT after the surgical procedure showed maxillary acute sinusitis, both right ethmoidal and frontal. He underwent a surgical procedure once again with a decompressive craniotomy and a new drain for the empyema. The antibiotic regimen was expanded. The clinical situation worsened, and the patient died. CONCLUSION: In this paper, we conclude that subdural empyemas that occur because of sinusitis, even though infrequent, are still present. The diagnosis is not easily detected, since the clinical situation may vary from an intense headache and poor general status to more severe manifestations such as hemiparesis, seizures, and alterations of consciousness in a short time.
