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Subdural Empyema
Last reviewed: 23.04.2024
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Subdural empyema is the accumulation of pus between the hard and spider webs of the brain. The disease is accompanied by an increase in body temperature, retardation, focal neurological symptoms and seizures. The diagnosis is based on CT data with contrast or MRI. Treatment consists in surgical drainage and antibiotic therapy.
[Causes of the subdural empyema
In most cases, subdural empyema is a complication of infection of the paranasal sinuses (especially frontal and latticular), but it can also be a consequence of otitis, traumatic brain injury, neurosurgical interventions, or bacteremia. The causative agents are the same as in the abscess of the brain. In children under 5, subdural empyema usually develops as a complication of bacterial meningitis, and with a decrease in the incidence of meningitis, the incidence of subdural empyema has correspondingly decreased. Frequent complications are thrombosis of cortical veins and brain abscess.
Symptoms of the subdural empyema
For several days against a background of fever, headache, inhibition, focal neurological symptoms and epileptic seizures, vomiting develop. When examined, meningeal signs and stagnant discs of the optic nerves are determined. Without treatment, the condition deteriorates rapidly, coma and death begin.
Diagnostics of the subdural empyema
CT with contrast enhancement or MRI can diagnose. Sowing of blood and intraoperative samples is carried out on aerobic and anaerobic nutrient media. Lumbar puncture is poorly informative, but can provoke a transgenic wedge.
If susdural empyema is suspected (based on persistence of symptoms, the presence of focal neurological deficit or risk factors), patients with meningeal signs are lumbar puncture contraindicated before exclusion of the mass effect by neuroimaging methods. In infants, subdural puncture can have diagnostic and therapeutic significance (decrease in intracranial pressure).
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Treatment of the subdural empyema
It shows an urgent operation to drain the empyema, as well as the corresponding sinus, if it is the source of infection. In anticipation of the results of the crop, empirical antibiotic therapy is prescribed (as in brain abscess), except for infants who may require antibiotics to treat concomitant meningitis. According to the testimony, subdural empyema requires the appointment of anticonvulsants and measures to reduce intracranial pressure.