Multiple sclerosis is a disease that affects the central nervous system, resulting in a variety of symptoms such as vision , physical activity and stability .Central positional vertigo as an initial multiple sclerosis symptoms is a rare case in the literature.

Subdural empyema is a rare intracranial infection with an accumulation of purulent material between the dura and arachnoid matter. We report a case of 17 years old presented with altered conscious level .CSF analysis showed increased WBCS. His situation has improved after treating by acyclovir, ceftriaxone, vancomycin and dexamethasone.