Failure of Computed Tomographic Scanning to Demonstrate Subdural Empyema

Abstract

Subdural empyema is a serious infection with a high mortality. The patients at risk either are known to have suppurative sinusitis or otitis or are being treated for these conditions. The clinical syndrome includes fever, headache, and focal neurological deficits, with seizures in a high percentage of cases. The course of the infection may be fulminant and may be confused with meningoencephalitis or cerebritis. Early diagnosis and surgical intervention are essential elements in treatment. There is a disturbing tendency for computed tomographic (CT) scans to fail to demonstrate acute subdural empyemas. Based on this experience, the diagnosis of subdural empyema must not be abandoned merely because of a nondiagnostic CT scan. (<i>JAMA</i>1981;246:1116-1118)