Mixed cerebral epidural abscess and epidural hematoma in an adolescent male: an illustrative case report.

Introduction and importance: Complex cranial anatomy can lead to unique and severe complications, such as the uncommon simultaneous presentation of an epidural abscess (EDA), cranial osteomyelitis, and spontaneous epidural hematoma (SEDH), posing potential diagnostic and management challenges. Case presentation: We present the case of a 15-year-old boy who presented with a 2-week history of headaches and painless swelling of the right eye accompanied by fever, poor appetite, and intermittent nasal discharge over 2 months. A computed tomography scan revealed a hypodense and hyperdense biconvex frontal region collection with an associated subgaleal collection thought to be an abscess. Emergency craniectomy, abscess drainage, and osteomyelitic bone removal were also performed. Intraoperatively, the hematoma and EDA were evacuated. Postoperatively, the patient showed rapid clinical improvement by day 1 and completed a 3-week course of intravenous antibiotics. The patient was subsequently discharged with no neurological deficits, a well-healed surgical site, and plans for follow-up and skull defect repair. Clinical discussion: The rarity of this condition accounts for the lack of established prevalence data. It may contribute to uncertainty in management; however, a standard approach incorporating thorough clinical assessment, imaging, and surgical intervention can lead to favorable clinical outcomes for patients. Conclusion: The rare occurrence of SEDH in association with EDA and cranial osteomyelitis poses significant challenges for clinicians in achieving early diagnosis. This delay can have serious implications for the patients. Therefore, it is crucial for clinicians to be aware of these peculiarities.