Subdural empyema pathophysiology: Difference between revisions
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===Intracranial Subdural Empyema=== | ===Intracranial Subdural Empyema=== | ||
Usually unilateral, the anatomy of the meninges|meningeal membranes contribute to the course and characteristics of the disease. The dura mater and the arachnoid mater | Usually unilateral, the anatomy of the [[meninges|meningeal membranes]] contribute to the course and characteristics of the disease. The [[dura mater]] and the [[arachnoid mater]] which define the initial limits of the [[empyema]], are joined only at the base of the [[brain]], along the [[falx cerebri]] and at the [[tentorium cerebelli]], being elsewhere held against each other, by the pressure of the [[brain]] and [[cerebrospinal fluid]]. The virtual space between these two [[meninges|meningeal membranes]] makes the perfect way for the infection to oread along the [[cerebral hemisphere]], inter-hemispheric fissure and [[posterior cranial fossa]]. | ||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: 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.[1] It consists of a localised collection of purulent material, usually unilateral, between the dura mater and the arachnoid mater and 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] 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. 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]
If diagnosis and treatment are prompt, complete recovery is usual.
Pathophysiology
A localised collection of pus between the dura mater and the arachnoid mater. It's a rare infection that accounts for about 15-25% of focal CNS infections and may occur in the intracranial space or in the spinal canal, being that the intracranial type is fairly more common that the spinal subdural empyema. Since the etiologic agents, the course of the disease and the treatment of this two types of empyema are different, they should be approached in separate ways.[3][1][2]
Intracranial Subdural Empyema
Usually unilateral, the anatomy of the meningeal membranes contribute to the course and characteristics of the disease. The dura mater and the arachnoid mater which define the initial limits of the empyema, are joined only at the base of the brain, along the falx cerebri and at the tentorium cerebelli, being elsewhere held against each other, by the pressure of the brain and cerebrospinal fluid. The virtual space between these two meningeal membranes makes the perfect way for the infection to oread along the cerebral hemisphere, inter-hemispheric fissure and posterior cranial fossa.
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 Greenlee JE (2003). "Subdural Empyema". Curr Treat Options Neurol. 5 (1): 13–22. PMID 12521560.
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.