Intracranial complications of paranasal sinusitis have become rare due to the 
use of antibiotics nowadays. However, several cases have been reported due the 
ability of paranasal sinusitis to cause serious complications. Once the 
infection spreads over the cranial structure, it could infect the orbits, 
underlying bones, meninges, adjacent veins, and brain. Subdural empyema is a 
rare but potentially life-threatening complication following paranasal sinusitis 
and should be considered as a neurological emergency. The location where 
subdural empyema may appear is a challenge in diagnosis and treatment. We report 
the case of a 17-year-old boy who presented in a state of somnolence due to 
interhemispheric and infratentorial subdural empyema with preseptal cellulitis 
secondary to pansinusitis. Early diagnosis and aggressive antibiotic treatment 
combined with neurosurgical operation were mandatorily implemented. The case was 
managed using a multidisciplinary approach including the ENT, eye, and nutrition 
departments. The boy achieved clinical improvement, with impairment of eye 
movement as the only persistent symptom before discharge. Daily supervision at 
the primary health care center with continuous antibiotic treatment was 
recommended to the patient. Pertinent literature with controversies in the 
management of subdural empyema will be briefly discussed in this case report.