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subdural empyema; subdural abscess
Etiology:
- predisposing conditions
- otorhinolic infections
- sinusitis, otitis media, mastoiditis
Epidemiology:
- accounts for 15-20% of all localized intracranal infections
Pathology:
- increased intracranial pressure
- meningeal irritation (meningitis)
- focal cortical inflammation (encephalitis)
Radiology:
- magnetic resonance imaging (MRI)
a) preferable to computed tomography (CT)
b) differentiates empyema from sterile effusions & subdural hematoma
Differential diagnosis:
- subdural hematoma
- sterile subdural effusion
- brain abscess
- epidural abscess
Complications:
- mortality 10-20%
- metastatic infection 5%
Management:
1) neurosurgical emergency
a) craniotomy allows wide exposure & adequate drainage [1]
b) decompression of the brain
c) evacuation of empyema
2) empiric antibiotic therapy (triple antibiotics)
a) vancomycin +
b) metronidazole +
c) cefepime, ceftazidime, or meropenem
Related
brain abscess
epidural abscess
subdural space
General
empyema
central nervous system (CNS) infection
References
- Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 18.
American College of Physicians, Philadelphia 2009, 2012, 2015, 2018.