Subdural abscess: causes, symptoms, diagnosis, treatment

A subdural abscess is a collection of pus under the dura mater of the brain.

Pathogenesis of subdural abscess

Subdural abscess develops as a complication of chronic purulent otitis media, especially cholesteatoma, much less often acute. It is localized in the middle or posterior cranial fossa. In the posterior cranial fossa, an abscess usually occurs with purulent labyrinthitis or with thrombosis of the sigmoid sinus.

Diagnosis of subdural abscess

Physical examination

The proximity of a subdural abscess to the pia mater and brain matter leads to the development of two groups of symptoms: meningeal and focal, corresponding to the localization of the abscess. When localized in the middle cranial fossa, focal symptoms may be in the form of light pyramidal signs on the opposite side. When localized in the posterior cranial fossa, cerebellar symptoms are observed (nystagmus, missing the finger-to-nose test). A remittent course of meningeal syndrome is considered characteristic of a subdural abscess. General cerebral symptoms are also possible. It is necessary to remember the possibility of a latent, asymptomatic course of a subdural abscess.

Laboratory research

In case of subdural abscess, moderate pleocytosis of cerebrospinal fluid is observed (up to 200-300 cells/μl).

Differential diagnostics

Differential diagnostics are performed with intracerebral abscess. In case of pronounced general cerebral symptoms, differential diagnostics with intracerebral abscess in the preoperative period becomes difficult.

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