Subdural empyema history and symptoms: Difference between revisions

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{{Subdural empyema}}
{{Subdural empyema}}
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{{CMG}} {{AE}} {{JS}}; {{AG}}


==Overview==
==Overview==
Subdural empyema, also referred to as [[subdural abscess]], [[pachymeningitis interna]] and [[circumscript meningitis]], is a life-threatening [[infection]].<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 [[pus|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 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>
If possible, a detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include prior [[neurosurgery]], [[sinusitis]], or [[mastoiditis]]. Common symptoms of subdural empyema include [[headache]], [[altered mental status]], [[vomiting]], and [[seizures]].  
The diagnosis of subdural empyema should be suspected, when a patient presents with a history of [[sinusitis]] and recent [[CNS]] signs and/or symptoms.<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><ref>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref>
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==
==History==
In '''children''' with subdural empyema, as a complication of sinusitis, the common presentation is: <ref name="Hendaus2013">{{cite journal|last1=Hendaus|first1=Mohammed A.|title=Subdural Empyema in Children|journal=Global Journal of Health Science|volume=5|issue=6|year=2013|issn=1916-9744|doi=10.5539/gjhs.v5n6p54}}</ref>
If possible, a detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include prior [[neurosurgery]], [[sinusitis]], or [[mastoiditis]].
*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, rapidly deteriorating
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: <ref name="Hendaus2013">{{cite journal|last1=Hendaus|first1=Mohammed A.|title=Subdural Empyema in Children|journal=Global Journal of Health Science|volume=5|issue=6|year=2013|issn=1916-9744|doi=10.5539/gjhs.v5n6p54}}</ref><ref name="pmid23358438">{{cite journal| author=Bruner DI, Littlejohn L, Pritchard A| title=Subdural empyema presenting with seizure, confusion, and focal weakness. | journal=West J Emerg Med | year= 2012 | volume= 13 | issue= 6 | pages= 509-11 | pmid=23358438 | doi=10.5811/westjem.2012.5.11727 | pmc=PMC3555596 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23358438 }} </ref>
==Symptoms==
*[[peri-orbital edema]]
Common symptoms of subdural empyema in children include:<ref name="Hendaus2013">{{cite journal|last1=Hendaus|first1=Mohammed A.|title=Subdural Empyema in Children|journal=Global Journal of Health Science|volume=5|issue=6|year=2013|issn=1916-9744|doi=10.5539/gjhs.v5n6p54}}</ref><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><ref name=Mandell>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages =  }}</ref>
*[[proptosis]]
*[[Altered mental status]]
*facial swelling
*[[Fever]]
*[[diplopia]]
*[[Headache]]
*pain when moving the eyes
*[[Nausea]]
*[[Vomiting]]
*[[Seizure]]
 
Common symptoms of subdural empyema in adults include:<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><ref name=Mandell>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages =  }}</ref>  
*[[Fever]] (generally > 38°C (100.5°F))
*[[Sinusitis]]
*[[Altered mental status]]
*[[Nausea]]
*[[Vomiting]]
*[[Headache]]
*[[Seizures]]
*[[Drowsiness]]
*[[Lethargy]]
*[[Aphasia|Inability to produce or comprehend language]]
*[[Neck stiffness]]
*[[Facial pain]]
*[[Coma]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Needs content]]
 
[[Category:Infectious disease]]


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{{WH}}
{{WS}}
{{WS}}

Latest revision as of 18:53, 18 September 2017

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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]; Anthony Gallo, B.S. [3]

Overview

If possible, a detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include prior neurosurgery, sinusitis, or mastoiditis. Common symptoms of subdural empyema include headache, altered mental status, vomiting, and seizures.

History

If possible, a detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include prior neurosurgery, sinusitis, or mastoiditis.

Symptoms

Common symptoms of subdural empyema in children include:[1][2][3]

Common symptoms of subdural empyema in adults include:[2][3]

References

  1. ↑ Hendaus, Mohammed A. (2013). "Subdural Empyema in Children". Global Journal of Health Science. 5 (6). doi:10.5539/gjhs.v5n6p54. ISSN 1916-9744.
  2. ↑ 2.0 2.1 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.
  3. ↑ 3.0 3.1 Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0-443-06839-9.


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