Subdural empyema overview: Difference between revisions
Joao Silva (talk | contribs) |
Joao Silva (talk | contribs) |
||
| Line 4: | Line 4: | ||
==Overview== | ==Overview== | ||
[[Subdural empyema]], also referred to as ''subdural abscess'', ''pachymeningitis interna'' and ''circumscript meningitis'', is a life-threatening infection, first reported in literature approximately 100 years ago.<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref> It consists of a localised collection of [[purulent]] material, usually unilateral, between the [[dura mater]] and the [[arachnoid mater]]. It accounts for about 15-22% of the reported focal intracranial [[infections]]. The empyema may develop intracranially (about 95%) or in the [[spinal canal]] (about 5%), and in both cases, it constitutes a [[Medical emergency|medical]] and [[Surgical emergency|neurosurgical emergency]].<ref name="pmid12521560">{{cite journal| author=Greenlee JE| title=Subdural Empyema. | journal=Curr Treat Options Neurol | year= 2003 | volume= 5 | issue= 1 | pages= 13-22 | pmid=12521560 | doi= | pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12521560 }} </ref> The intracranial type tends to behave like an expanding mass, causing clinical symptoms, such as [[fever]], [[lethargy]], [[headache]] and neurological deficits. These, result from the extrinsic compression of the [[brain]], caused not only from the [[inflammatory]] mass, but also from the [[inflammation]] of the [[brain]] and [[meninges]]. Because the [[subdural space]] has no septations, except in areas where [[arachnoid granulations]] attach to the [[dura mater]], the subdural empyema tends to spread quickly, until it finds those boundaries. | [[Subdural empyema]], also referred to as ''subdural abscess'', ''pachymeningitis interna'' and ''circumscript meningitis'', is a life-threatening infection, first reported in literature approximately 100 years ago.<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref> It consists of a localised collection of [[purulent]] material, usually unilateral, between the [[dura mater]] and the [[arachnoid mater]]. It accounts for about 15-22% of the reported focal intracranial [[infections]]. The empyema may develop intracranially (about 95%) or in the [[spinal canal]] (about 5%), and in both cases, it constitutes a [[Medical emergency|medical]] and [[Surgical emergency|neurosurgical emergency]].<ref name="pmid12521560">{{cite journal| author=Greenlee JE| title=Subdural Empyema. | journal=Curr Treat Options Neurol | year= 2003 | volume= 5 | issue= 1 | pages= 13-22 | pmid=12521560 | doi= | pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12521560 }} </ref> The intracranial type tends to behave like an expanding mass, causing clinical symptoms, such as [[fever]], [[lethargy]], [[headache]] and neurological deficits. These, result from the extrinsic compression of the [[brain]], caused not only from the [[inflammatory]] mass, but also from the [[inflammation]] of the [[brain]] and [[meninges]]. Because the [[subdural space]] has no septations, except in areas where [[arachnoid granulations]] attach to the [[dura mater]], the subdural empyema tends to spread quickly, until it finds those boundaries. | ||
In children, subdural empyema most often happens as a complication of [[meningitis]], while in adults it usually occurs as a complication of [[sinusitis]], [[otitis media]], [[mastoiditis]], [[trauma]] or as a complication of neurological procedures.<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref> The most common [[pathogens]] in the intracranial type are [[anaerobic]] and [[microaerophilic]] ''[[streptococci]]'', however others like ''[[Escherichia coli]]'' and ''[[Bacteroides]]'' may be present simultaneously. Spinal subdural empyemas, on the other hand, are almost always caused by''[[streptococci]]'' or by ''[[staphylococcus aureus]]''.<ref name="pmid12521560">{{cite journal| author=Greenlee JE| title=Subdural Empyema. | journal=Curr Treat Options Neurol | year= 2003 | volume= 5 | issue= 1 | pages= 13-22 | pmid=12521560 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12521560 }} </ref> | In children, subdural empyema most often happens as a complication of [[meningitis]], while in adults it usually occurs as a complication of [[sinusitis]], [[otitis media]], [[mastoiditis]], [[trauma]] or as a complication of neurological procedures.<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref> The most common [[pathogens]] in the intracranial type are [[anaerobic]] and [[microaerophilic]] ''[[streptococci]]'', however others like ''[[Escherichia coli]]'' and ''[[Bacteroides]]'' may be present simultaneously. Spinal subdural empyemas, on the other hand, are almost always caused by ''[[streptococci]]'' or by ''[[staphylococcus aureus]]''.<ref name="pmid12521560">{{cite journal| author=Greenlee JE| title=Subdural Empyema. | journal=Curr Treat Options Neurol | year= 2003 | volume= 5 | issue= 1 | pages= 13-22 | pmid=12521560 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12521560 }} </ref> | ||
The classic clinical syndrome includes acute [[fever]], that rapidly progresses into neurological deterioration, which if left untreated will eventually lead to a [[coma]] and death.<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref> The diagnostic procedure of choice is the [[MRI]] with [[gadolinium]] enhancement. | The classic clinical syndrome includes acute [[fever]], that rapidly progresses into neurological deterioration, which if left untreated will eventually lead to a [[coma]] and death.<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref> The diagnostic procedure of choice is the [[MRI]] with [[gadolinium]] enhancement. | ||
Since the clinical symptoms might be mild and unspecific initially, the rapid diagnosis and treatment are crucial. The sooner the proper treatment is initiated, the better the recovery will be. The treatment, for almost all causes, requires prompt [[surgical]] drainage and [[antibiotic]] therapy.<ref name="pmid12521560">{{cite journal|author=Greenlee JE| title=Subdural Empyema. | journal=Curr Treat Options Neurol | year= 2003 | volume= 5 | issue= 1 | pages= 13-22 | pmid=12521560 | doi= |pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12521560 }} </ref> With treatment, resolution of the [[empyema]] occurs from the dural side, and, if it is complete, a thickened [[dura mater|dura]] may be the only residual finding. | Since the clinical symptoms might be mild and unspecific initially, the rapid diagnosis and treatment are crucial. The sooner the proper treatment is initiated, the better the recovery will be. The treatment, for almost all causes, requires prompt [[surgical]] drainage and [[antibiotic]] therapy.<ref name="pmid12521560">{{cite journal|author=Greenlee JE| title=Subdural Empyema. | journal=Curr Treat Options Neurol | year= 2003 | volume= 5 | issue= 1 | pages= 13-22 | pmid=12521560 | doi= |pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12521560 }} </ref> With treatment, resolution of the [[empyema]] occurs from the dural side, and, if it is complete, a thickened [[dura mater|dura]] may be the only residual finding. | ||
Revision as of 03:54, 27 February 2014
|
Subdural empyema Microchapters |
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Subdural empyema overview On the Web |
|
American Roentgen Ray Society Images of Subdural empyema overview |
|
Risk calculators and risk factors for Subdural empyema overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; João André Alves Silva, M.D. [2]
Overview
Subdural empyema, also referred to as subdural abscess, pachymeningitis interna and circumscript meningitis, is a life-threatening infection, first reported in literature approximately 100 years ago.[1] It consists of a localised collection of purulent material, usually unilateral, between the dura mater and the arachnoid mater. It accounts for about 15-22% of the reported focal intracranial infections. The empyema may develop intracranially (about 95%) or in the spinal canal (about 5%), and in both cases, it constitutes a medical and neurosurgical emergency.[2] The intracranial type tends to behave like an expanding mass, causing clinical symptoms, such as fever, lethargy, headache and neurological deficits. These, result from the extrinsic compression of the brain, caused not only from the inflammatory mass, but also from the inflammation of the brain and meninges. Because the subdural space has no septations, except in areas where arachnoid granulations attach to the dura mater, the subdural empyema tends to spread quickly, until it finds those boundaries. In children, subdural empyema most often happens as a complication of meningitis, while in adults it usually occurs as a complication of sinusitis, otitis media, mastoiditis, trauma or as a complication of neurological procedures.[1] The most common pathogens in the intracranial type are anaerobic and microaerophilic streptococci, however others like Escherichia coli and Bacteroides may be present simultaneously. Spinal subdural empyemas, on the other hand, are almost always caused by streptococci or by staphylococcus aureus.[2] The classic clinical syndrome includes acute fever, that rapidly progresses into neurological deterioration, which if left untreated will eventually lead to a coma and death.[1] The diagnostic procedure of choice is the MRI with gadolinium enhancement. Since the clinical symptoms might be mild and unspecific initially, the rapid diagnosis and treatment are crucial. The sooner the proper treatment is initiated, the better the recovery will be. The treatment, for almost all causes, requires prompt surgical drainage and antibiotic therapy.[2] With treatment, resolution of the empyema occurs from the dural side, and, if it is complete, a thickened dura may be the only residual finding.
Pathophysiology
Bacterial or occasionally fungal infection of the skull bones or air sinuses can spread to the subdural space, producing a subdural empyema. The underlying arachnoid and subarachnoid spaces are usually unaffected, but a large subdural empyema may produce a mass effect. Further, a thrombophlebitis may develop in the bridging veins that cross the subdural space, resulting in venous occlusion and infarction of the brain. If diagnosis and treatment are prompt, complete recovery is usual.
Epidemiology and Demographics
It usually occurs in infancy.[3]
Causes
It can be associated with sinusitis.[4]
Diagnosis
Symptoms
Symptoms include those referable to the source of the infection. In addition, most patients are febrile, with headache and neck stiffness, and, if untreated, may develop focal neurologic signs, lethargy, and coma.
Laboratory Findings
The CSF profile is similar to that seen in brain abscesses, because both are parameningeal infectious processes.
Treatment
Medical Therapy
With treatment, including surgical drainage, resolution of the empyema occurs from the dural side, and, if it is complete, a thickened dura may be the only residual finding.
References
- ↑ 1.0 1.1 1.2 Agrawal, Amit; Timothy, Jake; Pandit, Lekha; Shetty, Lathika; Shetty, J.P. (2007). "A Review of Subdural Empyema and Its Management". Infectious Diseases in Clinical Practice. 15 (3): 149–153. doi:10.1097/01.idc.0000269905.67284.c7. ISSN 1056-9103.
- ↑ 2.0 2.1 2.2 Greenlee JE (2003). "Subdural Empyema". Curr Treat Options Neurol. 5 (1): 13–22. PMID 12521560.
- ↑ Wu TJ, Chiu NC, Huang FY (2008). "Subdural empyema in center". J Microbiol Immunol Infect. 41 (1): 62–7. PMID 18327428. Unknown parameter
|month=ignored (help) - ↑ Quraishi H, Zevallos JP (2006). "Subdural empyema as a complication of sinusitis in the pediatric population". Int. J. Pediatr. Otorhinolaryngol. 70 (9): 1581–6. doi:10.1016/j.ijporl.2006.04.007. PMID 16777239. Unknown parameter
|month=ignored (help)