Despite the availability of new broad-spectrum antibiotics, sinusitis 
occasionally causes significant morbidity and mortality. One serious 
complication of paranasal sinusitis is subdural empyema, a fulminating 
intracranial disease that is invariably fatal if not treated. The symptoms of 
subdural empyema may be mild and may be the same as those associated with 
sinusitis, or the infection may result in alteration of the level of 
consciousness and focal neurologic deficits. Rapid recognition and treatment of 
subdural empyema is extremely important. Before magnetic resonance imaging 
became available, computed tomography was used for rapid diagnosis of this 
infection. Magnetic resonance imaging, however, is now becoming the diagnostic 
tool of choice. Neurosurgical intervention and high doses of intravenously 
administered antibiotics are the mainstays of treatment. If treatment is 
initiated as soon as the diagnosis of subdural empyema is made, the patient has 
a good chance of recovering with no, or only slight, neurologic defects.