• Although rare, it is a serious life threatening entity of pediatric emergency medicine
• Must be in the differential of those with signs of increased intracranial pressure or focal deficit and hx of sinusitis, mastoiditis or cyanotic congenital heart disease.
• Investigation and diagnosis primarily with CT scan
• CSF studies demonstrate sterile fluid with elevated protein, and mildly elevated WBC
• Antibiotic coverage should be broad Naficillin/Vanc + Ceftriaxone + Metronidazole, until speciation and susceptibilities obtained from surgical specimen
• Steroids reserved only in cases of imminent herniation
• Controversy exists over prophylactic anticonvulsants
• Mortality recently <10% attributed to early diagnosis and appropriate antibiotic coverage.

References