Subdural Empyema Research Articles

Craniofacial Trauma in Pediatric Patients Following Winnowing Blade Injury-review of Literature.

In developing countries, during the harvest season, winnower blade injuries occur very frequently in children and results in lifelong disability. Nine children were managed during 1 month, all resulting due to winnower blade induced craniofacial trauma. PubMed search for “fan blade injury” showed two case series and three case reports. In our study, 88% had compound depressed fracture; brain matter leak in 56%, cerebrospinal fluid (CSF) leak alone in 22%. 66.7% had injury involving the frontal bone. Two patients had eye injury with visual loss. Seven underwent debridement craniectomy, five augmentation duroplasty and three contusectomy. All had vegetable material, sand particles. Complications in 66.6% with two cases of CSF leak settled with lumbar drain, one case of CSF otorrohea, 22.2% of wound infection, 44.4% wound dehiscence requiring redebridement and suturing in five patients. Two patients had postoperative seizures, two patients had hemiparesis both improved. Two low Glasgow Coma Scale remained so on postoperative period. One case of subdural empyema needed debridement and duroplasty with glue. No mortality noted. These findings were consistent with previous reports. Follow-up at 1.5 months showed good functional recovery. Early surgery debridement, steps to minimize postoperative infections, identifying putative risk factors early in the management are the principles of a successful treatment regimen.

Subdural empyema mimicking subacute subdural hematoma on CT imaging

Abstract We report a case of a 35-year-old male who was treated with craniectomy, subdural empyema evacuation, and subsequent intravenous antibiotic therapy. The patient presented with what appeared to be signs of a subacute subdural hematoma on imaging. A literature review was conducted to illustrate the similarities and differences in computed tomography (CT) findings for both subdural empyema, and subdural hematoma. High clinical suspicion, with prompt and appropriate imaging, and intervention are key to decrease the likelihood of neurological sequelae in the presence of subdural empyema.

Hemorragia Intracraniana Pós-Drenagem de Hematoma Subdural Crônico

O hematoma subdural crônico (HSDC) é comum na prática neurocirúrgica. Ocorre mais no idoso, sexo masculino e associado a traumatismo cranioencefálico. Pode se manifestar de várias formas clinicas. A tomografia computadorizada tem sido útil no diagnóstico e conduta. Na maioria dos casos o tratamento é cirúrgico e com bons resultados. Várias complicações podem ocorrer após a drenagem do HSDC como: recidiva do hematoma, pneumoencéfalo, empiema subdural e hemorragia intracraniana. Os autores relatam uma série de casos de hemorragias intracranianas pós-drenagem do HSDC e discutem sua fisiopatologia, diagnóstico, tratamento e resultados.

Simultaneous treatment of intracranial complications of paranasal sinusitis

PurposeThe objective of this study was to analyse 51 patients with intracranial complications of sinusitis treated in the Department of Otolaryngology and Laryngeal Oncology at Poznań University of Medical Sciences from 1964 to 2016.Materials and methodsMales made up a significant portion of study participants at 70.5%. Treatment included simultaneous removal of inflammatory focal points in the paranasal sinuses and drainage of cerebral and epidural abscesses and subdural empyemas under the control of neuronavigation preceded by the implementation of broad-spectrum antibiotics continuously for 4 weeks. Seventy-three intracranial complications were found among 51 patients. Of the 51 patients, 25 had frontal lobe abscesses (including multiple abscesses). Other complications included the following: 16 epidural abscesses, 9 subdural empyemas, 15 meningitis cases, 3 intracerebral abscesses, 3 sinus thrombosis cases and 2 patients with cerebritis. Co-occurrence of these complications worsened the state of the patient and increased the duration of treatment. Patients with frontal lobe abscesses had a better prognosis and less pronounced neurological symptoms in recent years versus earlier treatment approaches.ConclusionsSimultaneous treatment of intracranial complications of sinusitis is an effective treatment method that has minimal burden for the patient. From 1964 to 1978, three deaths (17%) were reported among patients with these complications. Since 1978, no deaths were reported in the clinic.

Odontogenic suppurative rhinosinusitis with oculo-orbital and cerebral complications - case series

Abstract BACKGROUND. Odontogenic rhinosinusal suppurations have a high potential for major ocular-orbital and cerebral complications because of the presence of anaerobic bacteria flora, with continuity, contiguity and haematogenous propagation mechanisms. This pathology is often diagnosed in other departments than ENT such as ophthalmology, neurosurgery or OMF surgery. MATERIAL AND METHODS. We present three clinical cases of odontogenic rhinosinusal suppurations with major complications: a 36-year-old patient with odontogenic pansinusitis complicated with orbital phlegmon and cerebral frontal lobe abscess; a 19-year-old patient with complicated maxillary-ethmoidal-frontal sinusitis complicated with frontal subdural empyema and frontal bone osteomyelitis (with a history of craniofacial trauma one year before); a 66-year-old patient with odontogenic maxillary-ethmoidal sinusitis complicated with orbital apex syndrome. RESULTS. The treatment was surgical, by external approach, with endoscopic nasal control, in interdisciplinary teams. We have associated massive antibiotic therapy. Surgical drainage for complicated rhinosinusitis should be done in emergency, within the first 24 hours after admission, according to guidelines. The bacteriological examination for aerobic and anaerobic flora can guide the diagnosis - two cases associated maxillo-ethmoidal aspergilloma lesions. The evolution of the cases was favourable. CONCLUSION. Interdisciplinary teams have successfully solved these complicated odontogenic rhinosinusal suppurations. Two of the cases were admitted and cured within 2 weeks, in the context of very hot weather, which exacerbated dormant dental infections.

Evaluation of patients with orbital infections.

Orbital tissue infections are common infections of childhood that can lead to severe complications. Herein, we aimed to evaluate the etiologic factors, diagnosis, follow-up, and treatment procedures in pediatric patients with orbital infections. This study was performed retrospectively between January 2014 and December 2015 in Cerrahpasa Medical Faculty Pediatric Infectious Disease Unit. Patients were studied for age, ophthalmologic examination features, laboratory and radiology results, treatment modalities, and the response to these treatments. Thirty-six patients (21 males, 15 females) with an average age of 71.43±42.24 months (5-168 months) participated in the study in the two-year period. Thirty-two patients (88.9%) had preseptal cellulitis, and four (11.9%) had orbital cellulitis. All patients had eyelid hyperemia, edema, and ocular pain, with chemosis in seven and proptosis in four cases. Twenty-five patients were admitted with fever. All cases were unilateral and 44.4% occurred secondary to paranasal sinusitis. All cases were treated with intravenous cefazolin-amikacin. The mean of duration of hospitalization was 12.02±8.75 days (range, 3-28 days) and the duration of parental antibiotics was 12.83±8.18 days (range, 7-21 days). All patients recovered without any vision loss, only one patient experienced subdural empyema complicating preseptal cellulitis. Most orbital tissue infections occur secondary to paranasal sinusitis in childhood. Orbital tissue infections can be complicated by brain abscess, cavernous sinus thrombophlebitis, and vision loss. Early diagnosis and proper antibiotic treatment are essential to prevent these life-threatening complications.

Neurological Complications of Acute and Chronic Sinusitis.

Acute and chronic sinusitis can give rise to a wide array of intracranial and orbital complications. These complications include brain abscess, subdural empyema, epidural abscess, meningitis, venous sinus thrombosis, frontal bone osteomyelitis, and orbital cellulitis and abscess. Despite numerous medical advances, these complications carry a risk of mortality and significant morbidity. Recent studies have shown improvement in both the mortality and the morbidity associated with the neurologic complications of acute and chronic sinusitis. However, there are still a large portion of patients with long-term sequelae, and the literature reports a morbidity rate of approximately 30%. The most common post-treatment morbidities include permanent changes in vision, seizures, and hemiparesis. Although the overall incidence of neurologic complications from a sinogenic source are rare, the potential long-term complications can be devastating making prompt diagnosis and treatment vital to improving outcomes.

Bacterial Infections of the CentralNervous System.

Bacterial infections of the central nervous system (CNS) continue to be an important cause of morbidity and mortality in children. The spectrum of bacterial infection of CNS includes; focal or multifocal infections like brain abscesses or subdural empyema; or more generalized or diffuse infections like pyogenic meningitis or ventriculitis. Focal and generalized infections may co-exist in an individual patient. Prompt and adequate antibiotic therapy and occasionally neurosurgical interventions are the cornerstone of effective management. The recent emergence of several multidrug-resistant bacteria poses a threat to the effective management of bacterial CNS infections. Several adjunctive anti-inflammatory and neuroprotective therapies are being tried, however; none has made a remarkable impact on the outcome. Consequently, bacterial CNS infections in children still remain a challenge to manage. In this review, authors discuss the current updates on the diagnostic and therapeutic aspects of bacterial infections of the CNS in children (post-neonatal age group).

Pediatric infratentorial subdural empyema: A case report

Background:Infratentorial subdural empyemas in children are extremely rare and potentially lethal intracranial infections. Delay in diagnosis and therapy is associated with increased morbidity and mortality.Case Description:A 4-year-old boy presented with cerebellar signs following a failed treatment of otitis media. Imaging studies revealed a subdural empyema and left transverse and sigmoid sinus thrombosis. The empyema was evacuated operatively and antibiotic treatment was initiated and administered for 6 weeks. The patient recovered fully and was discharged 4 weeks following the evacuation of the empyema.Conclusion:While prompt identification and treatment of subdural infratentorial empyemas are crucial for favorable outcomes, their diagnosis in children might be initially missed. This is, in part because they are so rare and in part, because imaging artifacts arising from the complex posterior fossa anatomy may obscure their presence in the computer tomography (CT) scan. Therefore, high level of suspicion is necessary, given the appropriate history and clinical presentation. In children, this is a recent history of protracted otitis media and central nervous system symptomatology—cerebellar or other.

Subdural empyema of otogenic etiology – case report

Subdural empyema consists in a pus collection located between dura mater and arachnoid. Rhinosinusitis, otitis media and mastoiditis are the most common causes of subdural empyema. Computed tomography and magnetic resonance are essential in the diagnosis of this pathology. The treatment of subdural empyema consists in immediate surgical drainage through craniotomy or by burr hole placement. The authors describe a subdural empyema caused by chronic suppurative otitis media that was drained by otoneurosurgical approach.

Giant subdural empyema in adult

Subdural empyema (SDE) is a fairly uncommon diagnosis, accounting for only 20% of intracranial infections, the usual source for SDE is direct extension from a contiguous source, such as acute sinusitis or otitis media, although in one-fourth of cases no source of infection is found. An 18-year-old man was admitted to our Institution because of dysarthria, lethargy and fever for 2 days. His medical history was marked by chronic otitis media badly treated by self-medication with several antibiotics. The first clinical examination revealed an increased body temperature of 37.6°C, heart rate of 82 beats per minute, blood pressure 140/74mmHg and respiratory rate of 18 breaths/minute. He was disorientated, his cranial nerves were intact and his pupils were reactive, round and equal. His white cell count was 6,620 per ¼L. His hemoglobin was 11.1g/dL and C-reactive protein was 80mg/L. The levels of his chemistries were normal. A computed tomography (CT) scan with contrast in emergency was performed and showed an extensive subdural fluid collection in the parietal site on the left side with peripheral enhancement, a mass effect was evident with displacement of the middle line structures toward the opposite side (A). An emergent craniotomy was done to evacuate the subdural empyema (B). A cultural examination was attempted with the fluid evacuation and showed no presence of bacteroides. Ceftriaxone and metronidazole were administered for 6 weeks. The patient was improved without neurological sequalae.

Subdural empyema as a complication of acute otitis media in a 67-year-old patient

The acute otitis media can be caused by viruses (nonsuppurative inflammation) and bacteria (suppurative inflammation). The suppurative inflammation is a risk factor of endocranial complications, including subdural empyema burdened with the high mortality. The authors present a clinical case of 67-year-old man treated by surgery because of subdural empyema in the course of the acute suppurative otitis media.

Successful management of subdural intracranial empyema linked with cerebral abscess as a consequence of pansinusitis

Successful management of subdural intracranial empyema linked with cerebral abscess as a consequence of pansinusitis

Subdural Empyema Treated by Continuous Irrigation and Drainage Catheter Insertion in a Young Adult Patient with Hemiparesis: A Case Report

Subdural Empyema Treated by Continuous Irrigation and Drainage Catheter Insertion in a Young Adult Patient with Hemiparesis: A Case Report

The proteome of pus from human brain abscesses: host-derived neurotoxic proteins and the cell-type diversity of CNS pus.

OBJECTIVE What determines the extent of tissue destruction during brain abscess formation is not known. Pyogenic brain infections cause destruction of brain tissue that greatly exceeds the area occupied by microbes, as seen in experimental studies, pointing to cytotoxic factors other than microbes in pus. This study examined whether brain abscess pus contains cytotoxic proteins that might explain the extent of tissue destruction. METHODS Pus proteins from 20 human brain abscesses and, for comparison, 7 subdural empyemas were analyzed by proteomics mass spectrometry. Tissue destruction was determined from brain abscess volumes as measured by MRI. RESULTS Brain abscess volume correlated with extracellular pus levels of antibacterial proteins from neutrophils and macrophages: myeloperoxidase (r = 0.64), azurocidin (r = 0.61), lactotransferrin (r = 0.57), and cathelicidin (r = 0.52) (p values 0.002-0.018), suggesting an association between leukocytic activity and tissue damage. In contrast, perfringolysin O, a cytotoxic protein from Streptococcus intermedius that was detected in 16 patients, did not correlate with abscess volume (r = 0.12, p = 0.66). The median number of proteins identified in each pus sample was 870 (range 643-1094). Antibiotic or steroid treatment prior to pus evacuation did not reduce the number or levels of pus proteins. Some of the identified proteins have well-known neurotoxic effects, e.g., eosinophil cationic protein and nonsecretory ribonuclease (also known as eosinophil-derived neurotoxin). The cellular response to brain infection was highly complex, as reflected by the presence of proteins that were specific for neutrophils, eosinophils, macrophages, platelets, fibroblasts, or mast cells in addition to plasma and erythrocytic proteins. Other proteins (neurofilaments, myelin basic protein, and glial fibrillary acidic protein) were specific for brain cells and reflected damage to neurons, oligodendrocytes, and astrocytes, respectively. Pus from subdural empyemas had significantly higher levels of plasma proteins and lower levels of leukocytic proteins than pus from intracerebral abscesses, suggesting greater turnover of the extracellular fluid of empyemas and washout of pus constituents. CONCLUSIONS Brain abscess pus contains leukocytic proteins that are neurotoxic and likely participate actively in the excessive tissue destruction inherent in brain abscess formation. These findings underscore the importance of rapid evacuation of brain abscess pus.

Subdural empyema as a rare complication of sinonasal infection: a case report and review of literature

Subdural empyema is a rare complication that causes high morbidity and mortality following sinusitis. Cranial complications should be considered in patients who develop neurological symptoms. These patients need surgery that should be performed by neurological and ear-nose-throat surgeons working together. A 14-year-old girl developed aphasia and hemiparesis from retrograde thrombophlebitis following sinusitis and we planned a two-stage surgery for the patient. In the first step, we drained the empyema by a craniotomy and functional endoscopic sinus surgery. In the second step, we drained a mature abscess. The purpose of this paper is to review the surgical and clinical management of intracranial complications from sinonasal infections.

A-69Comprehensive Neuropsychological Evaluation in a Child with Subdural Empyema Secondary to Acute Frontal Sinusitis: A Case Study

A-69Comprehensive Neuropsychological Evaluation in a Child with Subdural Empyema Secondary to Acute Frontal Sinusitis: A Case Study

Burr-Hole Craniostomy for Chronic Subdural Hematomas by General Surgeons in Rural Kenya.

Chronic subdural hematoma (cSDH) is a common condition that causes significant morbidity and mortality. In rural sub-Saharan Africa, there are very few neurosurgeons. Yet, cSDH is treatable by relatively simple surgical intervention with potential for rapid clinical improvement. We conducted a retrospective chart review of all patients with cSDH who underwent burr-hole trephination at Tenwek Hospital, Kenya, between July 2014 and July 2016. We extracted and compared the clinical presentation, risk factors, operative details, and outcomes. A total of 119 patients were identified with a mean age of 61.3years. The majority were men (80%). The main predisposing factors were trauma (54.6%) and alcohol intake (34.4%). Patients were generally managed with two burr-holes, irrigation, and a subdural drain, remaining for a median of 2days. Operations were assisted by general surgery residents under direct supervision of senior residents (46), general surgeons (65), and neurosurgeons (8). Complications included recurrence (5.2%), subdural empyema (2.5%), postoperative seizures (3.4%), and mortality (6.7%). Improvement of symptoms was noted in 91% of all patients. Operative management of cSDH can be safely performed in rural facilities by general surgeons familiar with the procedure and with the institutional resources. The majority of patients had satisfactory outcomes.

Brain and Spinal Abscesses

Brain and spinal abscesses are focal infections of the central nervous system that are often associated with significant morbidity and mortality if not recognized early and managed in a timely manner. In patients with brain abscess, the clinical manifestations run the gamut from indolent to fulminant; most are related to the size and location of the space-occupying lesion within the brain and the virulence of the infecting organism. Untreated spinal epidural abscess usually progresses through four stages: backache and focal vertebral pain, nerve root pain, spinal cord dysfunction, and complete paralysis. Magnetic resonance imaging is the diagnostic neuroimaging procedure of choice in patients with brain and spinal abscesses; on diffusion-weighted images, restricted diffusion may be seen and may help distinguish abscesses from necrotic neoplasms. Aspiration of the abscess is important to facilitate microbiologic diagnosis; after aspiration and submission of specimens for special stains, histopathologic examination, and culture, empirical antimicrobial therapy should be initiated based on stains of the aspirated specimen and the probable pathogenesis of infection. Once the infecting pathogen is isolated, antimicrobial therapy can be modified for optimal treatment. Surgical therapy is often required for the optimal approach to patients with brain and spinal abscesses. This review contains 6 figures, 5 tables, and 72 references. Key words: antimicrobial therapy for central nervous system infections, brain abscess, epidural abscess, focal intracranial infections, head trauma, infections in immunocompromised hosts, spine infections, subdural empyema, toxoplasmosis

Brain and Spinal Abscesses

Brain and spinal abscesses are focal infections of the central nervous system that are often associated with significant morbidity and mortality if not recognized early and managed in a timely manner. In patients with brain abscess, the clinical manifestations run the gamut from indolent to fulminant; most are related to the size and location of the space-occupying lesion within the brain and the virulence of the infecting organism. Untreated spinal epidural abscess usually progresses through four stages: backache and focal vertebral pain, nerve root pain, spinal cord dysfunction, and complete paralysis. Magnetic resonance imaging is the diagnostic neuroimaging procedure of choice in patients with brain and spinal abscesses; on diffusion-weighted images, restricted diffusion may be seen and may help distinguish abscesses from necrotic neoplasms. Aspiration of the abscess is important to facilitate microbiologic diagnosis; after aspiration and submission of specimens for special stains, histopathologic examination, and culture, empirical antimicrobial therapy should be initiated based on stains of the aspirated specimen and the probable pathogenesis of infection. Once the infecting pathogen is isolated, antimicrobial therapy can be modified for optimal treatment. Surgical therapy is often required for the optimal approach to patients with brain and spinal abscesses. This review contains 6 figures, 5 tables, and 72 references. Key words: antimicrobial therapy for central nervous system infections, brain abscess, epidural abscess, focal intracranial infections, head trauma, infections in immunocompromised hosts, spine infections, subdural empyema, toxoplasmosis