Subdural empyema history and symptoms: Difference between revisions

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==History and Symptoms==
==History and Symptoms==
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>
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>
*altered mental status
*altered mental status
*meningeal irritation
*meningeal irritation
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In adult patients with a subdural empyema, as a complication of sinusitis, the common presentation is a clinical triad of:
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)
#[[fever]] >38 ºC (100.5 ºF)
#[[sinusitis]]
#[[sinusitis]]
#neurological deficits, with a fast downhill course
#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:
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]]
*[[nausea]]/[[vomiting]]
*[[headache]], the most common complaint at presentation, initially localized to the side of the subdural infection, slowly progressing into a diffuse type.
*[[headache]], the most common complaint at presentation, initially localized to the side of the subdural infection, slowly progressing into a diffuse type.
Line 32: Line 32:
*mental status changes, from the increasing [[mass effect]] as well as increasing [[intracranial pressure]].
*mental status changes, from the increasing [[mass effect]] as well as increasing [[intracranial pressure]].
*[[coma]], as a result of an untreated subdural empyema, causing an increasing [[mass effect]] and increase in [[intracranial pressure]].
*[[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>
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>
*[[peri-orbital edema]]
*[[peri-orbital edema]]

Revision as of 02:32, 6 March 2014

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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]


In adult patients with a subdural empyema, as a complication of sinusitis, the common presentation is a clinical triad of:

  1. fever >38 ºC (100.5 ºF)
  2. sinusitis
  3. 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
  • aphasia, if the dominant hemisphere is affected
  • palsy of the 3rd and 6th cranial nerves
  • meningismus
  • contralateral motor deficits
  • mental status changes, from the increasing mass effect as well as increasing intracranial pressure.
  • 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]

References

  1. 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.
  2. Greenlee JE (2003). "Subdural Empyema". Curr Treat Options Neurol. 5 (1): 13–22. PMID 12521560.
  3. Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
  4. 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.
  5. 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.

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