Subdural Empyema as the Presenting Feature of a Cerebral Aneurysm in a Pediatric Patient in the Intensive Care Unit of a Teaching Hospital in Maputo, Mozambique: A Case Report

Background Cerebral aneurysms are rare in pediatric populations, accounting for less than 5% of all aneurysms. Etiologies are often congenital or infectious. To date, no cases of pediatric cerebral aneurysms have been reported in Mozambique. Case Presentation: We report the first documented case of a pediatric cerebral aneurysm in Mozambique. A 13-year-old boy was admitted to the Pediatric Intensive Care Unit (PICU) with a five-day history of sudden severe headache, fever, and right-sided focal seizures. Imaging revealed a right frontal parafalcine subdural empyema, which was surgically drained. Although the patient initially improved, he was readmitted 15 days later with a sudden loss of consciousness and generalized seizures. Encephalic Computed Tomography and angiography revealed intraventricular hemorrhage and ruptured aneurysms of the pericallosal and right middle cerebral arteries. Neurosurgical intervention was not available; The blood culture isolated Staphylococcus aureus , and broad-spectrum was considered, as well as supportive care, and the patient survived with neurological sequelae. Discussion This case highlights a rare and severe presentation of pediatric cerebral aneurysm associated with subdural empyema of likely infectious etiology. The vascular territories affected were atypical, and diagnosis was delayed due to the condition's rarity and limited resources. Conclusion Despite being rare, cerebral aneurysms in children should be considered in cases of neurological deterioration, especially with signs of intracranial infection. Early neuroimaging and timely neurosurgical care are essential for better outcomes in resource-limited settings.