Subdural empyema history and symptoms
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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] The diagnosis of subdural empyema should be suspected, when a patient presents with a history of sinusitis and recent CNS signs and/or symptoms.[1][3] 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.
History and Symptoms
In children with subdural empyema, as a complication of sinusitis, the common presentation is: [4]
- altered mental status
- meningeal irritation
- signs and/or symptoms of increased intracranial pressure, such as: headache, nausea/vomiting, ocular palsies and papilledema.
- seizures
In adult patients with a subdural empyema, as a complication of sinusitis, the common presentation is a clinical triad of:
- fever >38 ºC (100.5 ºF)
- sinusitis or recent history of sinusitis (important to keep in mind that previous sinusitis antibiotic therapy might mask superficial symptoms, so that the empyema may be presented with symptoms of brain abscess).
- neurological deficits, with a fast downhill course
The signs and symptoms of subdural empyema, in the setting of sinusitis, may precede the diagnosis anywhere between 12 days to 6 weeks. Other symptoms may include:
- nausea/vomiting
- headache, the most common complaint at presentation, initially localized to the side of the subdural infection, slowly progressing into a diffuse type.
- seizures, focal or generalised. May result from the focal irritative effect of the infection on the cortex, or result from cortical venous infarction
- drowsiness
- stupor
- palsy of the 3rd and 6th cranial nerves
- contralateral motor deficits
- speech difficulty
- mental status changes, from the increasing mass effect as well as increasing intracranial pressure.
- facial pain, in case of an abscess near the petrous portion of the temporal bone, compressing the cranial nerves
- coma, as a result of an untreated subdural empyema, causing an increasing mass effect and increase in intracranial pressure.
Since there may be extra cranial manifestations of the subdural empyema, the physician should look for the possibility of: [4][5]
- peri-orbital edema
- proptosis
- facial swelling
- diplopia
- pain when moving the eyes
References
- ↑ 1.0 1.1 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.
- ↑ 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.
- ↑ 4.0 4.1 Hendaus, Mohammed A. (2013). "Subdural Empyema in Children". Global Journal of Health Science. 5 (6). doi:10.5539/gjhs.v5n6p54. ISSN 1916-9744.
- ↑ Bruner DI, Littlejohn L, Pritchard A (2012). "Subdural empyema presenting with seizure, confusion, and focal weakness". West J Emerg Med. 13 (6): 509–11. doi:10.5811/westjem.2012.5.11727. PMC 3555596. PMID 23358438.