Q: 32 year old otherwise healthy male with 2 weeks history of sinusitis presented with siezure. ER physician called you while he sent patient to CT scan. What would be your primary concern and line of action?
Answer: Neurological symptoms after prolong bout of sinusitis is highly suggestive of Subdural empyema.
Subdural empyema is a neurosurgical emergency and beside instituting antibiotics and anti-seizure meds, it would be appropriate to ask neurosurgical service to review CT scan while patient is in neuroradiology department. It has a tendency to spread rapidly through the subdural space.