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]

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 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).
  3. 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:

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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