Diagnosis Of Subdural Empyema Research Articles

Infantile supratentorial subdural empyema managed by percutaneous aspiration: an outcome study in a Nigerian city.

Subdural empyema (SDE), a common neurosurgical emergency in the developing countries, accounts for 15%-20% of localised paediatric intracranial infections. In regions where modern diagnostic tools are scarce and inaccessible, detection of SDE may be delayed with subsequent poor outcome. Percutaneous subdural aspiration in patients with open anterior fontanel may be the only surgical option in resource-poor regions of the world. This review focuses on the management outcome, including neurological outcome of these children. Clinical charts of children with SDE and treated by percutaneous subdural tap between February 2006 and August 2014 were reviewed. Demographic, clinical, radiological, bacteriological parameters and outcome data were analysed. Forty-five children with a mean age of 10.6 ± 6.2 months (range: 2-17 months) and followed up for a median duration of 16.4 months were included. The most frequent clinical features were enlarged head circumference, fever, focal neurologic deficits and altered level of consciousness. Diagnosis of SDE was confirmed using trans-fontanel ultrasound scan in 32 (71.1%) children, computerised tomography in 12 (26.7%) children and magnetic resonance imaging in one (2.2%) child. SDE was unilateral in 73.3% and bilateral in 26.7%. In 23 (51.1%) children with a positive culture, Staphylococcus aureus (n = 10), anaerobes (n = 7), Escherishia coli and Haemophilus influenza (n = 6 each) were the most common organisms. Forty-three children (95.6%) survived, 36 of which had good Glasgow outcome score. Seven children still had moderate deficits at 3 months. Treatment of SDE in young children with patent fontanel using percutaneous subdural tap has good therapeutic and neurological outcome.

Subdural Empyema Complicating Bacterial Meningitis: A Challenging Diagnosis in a Patient with Polysubstance Abuse.

Subdural empyema (SDE) and cerebrovascular accident (CVA) are uncommon life-threatening complications of bacterial meningitis, which require urgent neurosurgical intervention to prevent adverse outcomes. Clinicians must be vigilant of the onset of focal neurologic deficits or seizure activity to establish the diagnosis of SDE. Streptococcus pneumoniae accounts for <1% of pyogenic brain abscesses. This case describes a presentation of community acquired pneumococcal pneumonia in which the diagnosis of SDE with vasculitis induced CVA was confounded by concomitant substance abuse and sedation.

Parafalcine Subdural Empyema in a Woman with Recurrent Acute Otitis Media

Subdural empyema (SDE) most frequently arises as a complication of paranasal sinusitis and is a serious intracranial infection. Parafalcine SDE, resulting from acute otitis media, is a rare phenomenon. Here, we report the case of 57 year old woman, with a history of nasopharyngeal carcinoma (NPC) with radiotherapy, 28 years ago and recent diagnosis of recurrent acute otitis media, who was admitted to the emergency department with a 2 days history of progressive right-sided limb weakness. Neurological examination revealed right-sided hemiparesis without meningeal signs. Non-enhanced computed tomography (CT) scans of the brain revealed a hypodense lesion in the left parafalcine region. Gadolinium-enhanced magnetic resonance imaging demonstrated layers of rim-enhancing subdural fluid collection and swelling of the surrounding brain, suggestive of empyema. The patient underwent surgical evacuation of empyema and was treated with intravenous antibiotics for 6 weeks. The patient recovered well without neurological deficits. Follow-up brain CT 6 weeks later showed complete resolution of previous lesions. Acute otitis media complicated by SDE is a rare clinical phenomenon that carries a high mortality rate. The complication risk may be higher in NPC patients following radiotherapy. Early diagnosis of SDE and prompt surgical evacuation of purulent material can result in a full recovery.

An unusual case of meningococcal meningitis complicated with subdural empyema in a 3 month old infant: a case report.

Subdural empyema is an unusual complication of meningococcal meningitis, and in acute cases can be rapidly fatal. We present a case of an 8 week old infant who presented with atypical Neisseria meningitis with bifrontal subdural empyema formation. Through the utilisation of modern polymerise chain reaction tests on cerebrospinal fluid samples, we were able to confirm the diagnosis and institute appropriate treatment. Early surgical intervention and appropriate intravenous antibiotics meant that the patient fully recovered. In summary, early treatment of meningitis without adequate microbiological investigations can complicate later diagnosis of subdural empyema. Early suspicion of empyema should be considered when patient fails to improve after 48 hrs, seizures are a late sign and gives a poorer prognosis. Computed tomography scanning is still the modality of choice although in this case, magnetic resonance imaging had its benefits. Polymerase chain reaction of cerebrospinal fluid testing may also provide an important confirmatory test in future.

An unusual case of meningococcal meningitis complicated with subdural empyema in a 3 month old infant: a case report

Subdural empyema is an unusual complication of meningococcal meningitis, and in acute cases can be rapidly fatal. We present a case of an 8 week old infant who presented with atypical Neisseria meningitis with bifrontal subdural empyema formation. Through the utilisation of modern polymerise chain reaction tests on cerebrospinal fluid samples, we were able to confirm the diagnosis and institute appropriate treatment. Early surgical intervention and appropriate intravenous antibiotics meant that the patient fully recovered. In summary, early treatment of meningitis without adequate microbiological investigations can complicate later diagnosis of subdural empyema. Early suspicion of empyema should be considered when patient fails to improve after 48 hrs, seizures are a late sign and gives a poorer prognosis. Computed tomography scanning is still the modality of choice although in this case, magnetic resonance imaging had its benefits. Polymerase chain reaction of cerebrospinal fluid testing may also provide an important confirmatory test in future.

Empiema subdural secundario a sinusitis: cuatro casos pediátricos

Perinasal sinus infections is a common and benign condition in most pediatric cases. Because of the widespread use of antibiotics, intracranial extension of sinusitis is rarely seen today. Nevertheless, the clinician must be aware of the gravity of this condition, because late recognition and delay in treatment can increase mortality and morbidity. The authors made a retrospective study of pediatric patients admitted to Garcia de Orta Hospital between 1996 and 2001 with the diagnosis of subdural empyema and sinusitis.Four patients were identified, with ages between 9 and 13 years. Prodromal manifestations of sinusitis were present in all, followed several days later by headaches, fever, vomiting and neurological abnormalities. Two patients presented in the emergency department with an acute confusional state and a non convulsive status epilepticus. The other two patients had a longer duration of disease, severe deterioration of consciousness and focal neurologic signs. Medical treatment was started in all cases at admission, but none improved significantly before being submitted to surgical intervention, which was repeated several times in two patients. Streptococcus milleri and anaerobic organisms were isolated. There was no mortality and global evolution was favorable, with a median follow up of 32 months.Clinical presentation of subdural empyema can be relatively inespecific, requiring a high degree of suspicion. Facing a young adolescent with fever of unknown origin associated with any neurological abnormality and previous history of sinusitis, neuroradiological investigation shoul be asked. Early diagnosis and treatment are the mainstays of successful outcome.

辺縁性歯周炎から波及したと推察された硬膜下膿ようの１例

We report our clinical experience with a patient who intially had marginal periodontitis, which progressed to peritonsillitis and subdural empyema.The patient was a 57-year-old woman. On June 16, she visited our department. The diagnosis of peritonsillitis originating in 6 was made at our department. Chemotherapy was given and the pus was discharged by incision. The deeply spreading abscess and the presence of headache before surgery suggested that the inflammation extended into the head. A computed tomographic scan revealed that the left side parieto-occipital lobe had an abnormal appearance. After consultation with the department of neurosurgery, Nihon University, School of Medicine, a diagnosis of subdural empyema was established. The patient was transferred to the department of neurosurgery, and drainage by craniotomy was carried out on June 20. The pathogens were shown to be Streptococcus constellatus and Bacteroides mellaninogenicus group. On July 4, surgery was agein performed to create a path for drainage. A magnetic resonance imaging scan showed no evidence of the abscess on July 18, and the drain was removed. On August 19, the patient was discharged because symptoms had improved.

The EEG in the diagnosis of subdural empyema

The EEG findings in 9 patients with a subdural empyema are reported. In all cases the EEG, recorded before the diagnosis had been established, contained focal zeta waves, extensive unilateral depression of cortical activity and, in all but one, a diffuse slowing of the background activity. This combination has not been reported before in the literature and it is concluded that in its presence the existence of a subdural empyema should be seriously considered. Comparison with CT scan findings in 3 cases indicated that sometimes EEG may be more sensitive than CT scanning in the diagnosis of subdural empyema. The value of EEG and CT scan in the diagnosis of patients with an acute or subacute bacterial meningo-encephalitis is briefly discussed.

Subdural Empyema - Continuing Diagnostic Problems in the CT Scan Era

Fourteen cases of subdural empyema seen in Oxford since the introduction of the CT scanner are reviewed; 11 were male and 12 survived. The clinical presentation was stereotyped and characterised by severe headache, fever and meningism followed after a few days by rapidly progressive drowsiness, focal signs, papilloedema and seizures. All had radiological evidence of paranasal sinus disease (particularly frontal) although this was not apparent clinically in the majority. Plain skull and sinus radiographs remain important early investigations. Over-reliance can be placed on the CT scan which initially may be normal or show only non-specific hemisphere swelling. Parafalcine collections are easily missed. The diagnosis of subdural empyema remains difficult and a high index of clinical suspicion is required. Outcome depends on prompt treatment with parenteral antibiotics and surgical drainage.

Failure of Computed Tomographic Scanning to Demonstrate Subdural Empyema

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)

Failure of computed tomographic scanning to demonstrate subdural empyema

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)