Subdural Empyema Research Articles

Subcutaneous Dissemination in Highly Aggressive Intracranial Glioblastoma: Case Report and Literature Review

Glioblastoma (GBM) is a highly invasive and incurable primary central nervous system (CNS) tumor. Despite its aggressive behavior, extracranial metastases are rare, with an estimated incidence of less than 2%. In our literature review, we found only 21 reported cases of skin and soft tissue dissemination. We report a case of an early (two and a half months) postoperative skin and muscle flap-associated dissemination of a temporal glioblastoma. The particular aspect of this case, besides its rarity, is that the clinical presentation, the image reports and even the surgical findings were always in favor of a postoperative subdural empyema and epicranial abscesses. The diagnosis of soft tissue dissemination was only possible after negative microbiological cultures and histopathological confirmation of muscle and skin invasion by the tumor. This case illustrates the rare but potential risk of myocutaneous flap tumor dissemination through the durotomy/craniotomy site that can mimic a much more common, post-surgical infection.

Use of subdural drain for chronic subdural haematoma? A 4-year multi-centre observational study of 302 cases

Chronic subdural haematoma (CSDH) is a common neurosurgical condition and is more prevalent in the ageing population. Studies have suggested that placement of subdural drains after burr-hole drainage was associated with lower recurrence rates. However, a considerable proportion of surgeons remained unconvinced of the effectiveness of drain placement and concerns exist with the potential complications this additional manoeuvre entails such as infection or bleeding. The aim of the present study is to evaluate the impact of subdural drain on CSDH recurrence and its safety. This is a multicentre observational study. Data of consecutive patients with burr-hole drainage performed for CSDH in three hospitals in Hong Kong during a four-year period from January 2008 to December 2011 were prospectively collected and retrospectively analysed. The primary outcome was symptomatic recurrence requiring re-operation. Secondary outcomes included the modified Rankin scales (mRS), morbidity and mortality at six months. A total of 302 patients were identified. The recurrence rate was 8.72% (13/149) with drain placement versus 16.3% (25/153) with no drain (Odds Ratio=0.489, 95%CI 0.240–0.998; p=0.0463). Local wound infection, subdural empyema, acute subdural haematoma and other complications had no significant difference. Six-month mRS, 30-day mortality and six-month mortality were comparable in both groups. In conclusion, the use of subdural drain significantly reduced recurrence with no significant increase in complications.

Actinomycotic brain abscess

Actinomycosis is caused by Gram-positive filamentous anaerobic organisms of genus Actinomyces, which are commensals of mucosal membranes of the oropharyngeal cavity, and gastrointestinal and genitourinary tracts. Central nervous system involvement is rare and may present as cerebral abscess, meningitis, meningoencephalitis, subdural empyema or epidural abscess. The radiological appearances of actinomycotic brain abscesses are not well recognized. Here, we present the characteristic imaging features of an actinomycotic brain abscess.

Orbital Cellulitis with Pansinusitis and Subdural Empyema

Orbital Cellulitis with Pansinusitis and Subdural Empyema

A 14-Year Review of Socioeconomics and Sociodemographics Relating to Intracerebral Abscess, Subdural Empyema, and Epidural Abscess in Southeastern Louisiana.

Secondary intracranial infections are a persistent health concern despite advancements in medicine and improvements in surgical care. Previous studies have reported on the incidence of infection and outcomes in the immunocompromised patient, yet few studies have investigated demographic elements linked to contracting a secondary intracranial infection, a preventable disease. The aim of this study was to uniquely describe immunocompetent pediatric patients with secondary intracranial infections and further examine the socioeconomic and sociodemographic factors that may put them at higher risk of acquiring an infection. A retrospective review was conducted for patients presenting with intracranial infections to the regional Children's Hospital between 2001 and 2014. Patients with a previous history of neurosurgical disease or procedure were excluded. A Z test for proportions was performed to detect significant variations between demographic groups. A total of 41 patients were included in the study sample. From 2001 to 2014, 63.4% of patients diagnosed with intracranial infections were white, and 36.5% were other/nonwhite. This incidence of infection varied significantly between white and nonwhite (P = .015). At Children's Hospital, 19.5% of patients were privately insured and 80.5% had public health insurance. The most notable variation of a secondary intracranial infection was health insurance; 51% of Louisiana children carry public insurance, yet they represent more than 80% of disease incidence (P < .001). Improving access to care and treatment for underinsured populations may contribute to a decrease in secondary intracranial infection cases. CHD, congenital heart diseaseED, emergency departmentICD-9, International Classification of Diseases, Ninth RevisionRR, relative risk.

Subdural Empyema Caused by Nontyphoidal &lt;i&gt;Salmonella&lt;/i&gt; in a Patient with a Previous Evacuation of Subdural Hematoma

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Spontaneous Subdural Empyema Following a High-Parasitemia Falciparum Infection in a 58-Year-Old Female From a Malaria-Endemic Region: A Case Report.

Malaria remains a significant public health problem of the tropical world. Falciparum malaria is most prevalent in the sub-Saharan African region, which harbors about 90% of all malaria cases and fatalities globally. Infection by the falciparum species often manifests with a spectrum of multi-organ complications (eg, cerebral malaria), some of which are life-threatening. Spontaneous subdural empyema is a very rare complication of cerebral malaria that portends a very poor prognosis unless diagnosed and treated promptly. We report a case of spontaneous subdural empyema in a 58-year-old woman from Tanzania who presented with high-grade fever, decreased urine output, and altered sensorium.

Considerations in the management of giant frontal mucoceles with significant intracranial extension: A systematic review.

Giant frontal mucoceles, characterized by significant intracranial and/or intraorbital extension, can present with significant neurologic symptoms. Although typical mucoceles are managed endoscopically, giant mucoceles are often treated with an open or combined approach due to various concerns, including frontal lobe displacement, size, and rapid decompression of the intracranial component. The impact of significant intracranial extension on outcomes is not well described. This review studied key neurologic considerations in the management of giant frontal sinus mucoceles and analyzed outcomes of different management strategies. Systematic literature review by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Thirty-two articles, which represented 85 cases, met inclusion criteria. Neurologic symptoms on presentation ranged from headache (24.7%) and vision loss (12.9%) to extremity weakness (1.2%), frontal lobe syndrome (2.4%), and seizures (4.7%). Twenty-eight patients were treated endoscopically (34.1%), and 54 (65.9%) were treated with an external approach. Twenty-five of the open procedures included a craniotomy. Indications for the open approach included subdural empyema, enucleation, or large anterior table defects. Perioperative antibiotics were not consistently used. No perioperative seizures were reported with any approach. There were six cerebrospinal fluid leaks, all in the patients who underwent open procedures. The overall recurrence rate was 3.5%, with no recurrences reported in patients treated with an open approach. Follow-up ranged from 1 week to 8 years. Giant frontal mucoceles often present with various neurologic symptoms. Both open and endoscopic techniques offer excellent results. Endoscopic management is effective and preferred, except in special circumstances. An interdisciplinary team approach should be used to optimize surgical planning.

Intracranial Suppurative Complications of Sinusitis.

Intracranial complications of paranasal sinusitis have become rare due to widespread and early use of antibiotics. Potentially life-threatening intracranial complications of sinusitis include subdural empyema, epidural and intracerebral abscess, meningitis, and sinus thrombosis. Patients with intracranial complication of sinusitis can present without neurological signs, which may delay diagnosis and correct treatment. Our aim was to evaluate the diagnostics, treatment, and outcome of sinusitis-related intracranial infections at our tertiary referral hospital with a catchment area of 1.9 million people. We retrospectively collected data on all patients diagnosed and treated with an intracranial infection at the Helsinki University Hospital, Helsinki, Finland, during a 10-year period between 2003 and 2013. Six patients were diagnosed to have a sinusitis-related intracranial infection. Four patients had an epidural abscess, one both an epidural abscess and a subdural empyema and one a subdural empyema. The most common presenting complaint was headache (100%) followed by fever (83%), vomiting (50%), nasal congestion (50%), forehead lump (34%), and neck stiffness (17%). All patients were managed surgically. Most (83%) patients recovered to premorbid state without neurological sequelae. One patient died intraoperatively. Patients with a sinusitis-related intracranial suppuration typically present with signs of raised intracranial pressure rather than signs of sinusitis. Most are likely to need neurosurgical intervention and evacuation of the abscess without delay.

Which should be appropriate surgical treatment for subtentorial epidural empyema? Burr-hole evacuation versus decompressive craniectomy: Review of the literature with a case report.

Subtentorial empyema is a rare intracranial complication of chronic otitis media. Moreover, if not correctly treated, it is a life-threatening infection. Epidural and subdural empyemas on subtentorial space have different effects. This difference is not mentioned in literature. If the distinction can be made, surgical treatment method will be different, and the desired surgical treatment may be less minimal invasive. A 26-year-old male patient was found to have developed epidural empyema in the subtentorial space. We performed a burr-hole evacuation in this case because there was low cerebellar edema, Also, the general condition of the patient was good, the empyema was a convex image on the lower surface of tentorium on magnetic resonance images, and when the dura mater base is reached during mastoidectomy for chronic otitis media, we were observed to drain a purulent material through the epidural space. After 10 days from surgery increased posterior fossa edema caused hydrocephalus. Therefore, ventriculoperitoneal shunt insertion was performed. The patient fully recovered and was discharged after 6 weeks. Complete correction in the posterior fossa was observed by postoperative magnetic resonance imaging. Burr-hole evacuation from inside of the mastoidectomy cavity for subtentorial epidural empyema is an effective and minimal invasive surgical treatment.

Neurological sequelae of bacterial meningitis

We reported on occurrence and impact of neurological sequelae after bacterial meningitis. We reviewed occurrence of neurological sequelae in children and adults after pneumococcal and meningococcal meningitis. Most frequently reported sequelae are focal neurological deficits, hearing loss, cognitive impairment and epilepsy. Adults with pneumococcal meningitis have the highest risk of developing focal neurological deficits, which are most commonly caused by cerebral infarction, but can also be due to cerebritis, subdural empyema, cerebral abscess or intracerebral bleeding. Focal deficits may improve during clinical course and even after discharge, but a proportion of patients will have persisting focal neurological deficits that often interfere in patient's daily life. Hearing loss occurs in a high proportion of patients with pneumococcal meningitis and has been associated with co-existing otitis. Children and adults recovering from bacterial meningitis without apparent neurological deficits are at risk for long-term cognitive deficits. Early identification of neurological sequelae is important for children to prevent additional developmental delay, and for adults to achieve successful return in society after the disease. Neurological sequelae occur in a substantial amount of patients following bacterial meningitis. Most frequently reported sequelae are focal neurological deficits, hearing loss, cognitive impairment and epilepsy.

Nontyphoidal Salmonellosis, Human Immunodeficiency Virus Infection, and Ischemic Stroke.

Nontyphoidal Salmonella infection and stroke are major causes of morbidity and mortality worldwide, with increased risk in the human immunodeficiency virus (HIV)-infected population. We report a rare case of ischemic stroke associated with Salmonella enteritidis subdural empyema in an older HIV-infected patient with multimorbidity, despite surgery and treatment with susceptible antimicrobial drugs.

Parafalcine Subdural Empyema-A Rare Entity

Subdural empyema (SDE) is a significant cause of neurological morbidity and mortality. It should be recognized early and treated as an emergency. Although convexity subdural empyema is not so uncommon but parafalcine subdural empyema is quite rare. A recent case of parafalcine subdural empyema managed at Prince Abdullah Bin Abdulaziz Hospital, Bisha (KSA) is discussed. The epidemiology, pathophysiology, bacteriology, clinical features, radiographic findings and treatment of this life-threatening entity are reviewed

Cerebellopontine angle subdural empyema in a 2-years old patient with bilateral mastoiditis - a life-threatening condition. Case presentation and review of literature

AbstractInfratentorial subdural empyema is a life-threatening condition, the common source being an ear infection. We present a 2-year old boy treated for bilateral mastoiditis, with infratentorial-left cerebellopontine angle subdural empyema. Clinical presentation encompassed a systemic febrile illness, headaches, and a stiff neck. Empyema was diagnosed with computed tomography and magnetic resonance imaging. The patient was successfully treated with surgery and appropriate antibiotics. Empyema should be considered in patients with ENT infection associated with neurological signs that suggest a posterior fossa lesion.

A Rare Cause of Calcified Subdural Empyema and Ventriculitis in a Pediatric Patient: Achromobacter Denitrificans.

Intracranial infections in the pediatric age group are still important causes of morbidity in developing countries. A 2-year-old male patient presented with acute onset of seizures and loss of consciousness to our emergency department with a past history of being followed for hypogammaglobulinemia. Unenhanced computerized tomography scan of the brain revealed a right frontoparietal peripherally calcified extraaxial collection, brain edema and a left sided shift. Contrast enhanced magnetic resonance imaging revealed a subdural empyema associated with the brain parenchyma and the ventricular system. In spite of a decompression procedure and subsequent medical therapy, the patient succumbed on the 9. postoperative day. This is the first case report of a pediatric patient with subdural empyema and ventriculitis due to Achromobacter denitrificans.

Intracranial subdural empyema after surgery for lumbar lipomyelomeningocele: A rare complication

Background:Surgery is routinely recommended for lumbar lipomyelomeningocele, especially in the setting of tethered cord syndrome. The most common complications are wound infections and cerebrospinal fluid (CSF) leak, which remain confined to the surgical site. To the best of our knowledge, there have been no prior reports relating an intracranial subdural empyema following detethering surgery. Prompt diagnosis is essential since subdural empyema is a neurosurgical emergency.Case Description:The patient was an 11-month-old male who underwent detethering surgery for a lumbar lipomyelomeningocele. This was followed by wound drainage consistent with CSF leak, requiring revision. Cultures grew three aerobes (Escherichia coli, Enterococcus, and Klebsiella) and three anaerobes (Clostridium, Veillonella, and Bacteroides). He was started on cefepime, vancomycin, and flagyl. The patient required two more wound revisions and placement of an external ventricular drain (EVD) secondary to persistent wound leakage. A subsequent magnetic resonance imaging (MRI) brain was carried out due to protracted irritability, which revealed extensive left subdural empyema along the parietooccipital region and the inferior and anterior temporal lobe. He underwent evacuation of the subdural empyema where cultures exhibited no growth. Subsequently, he progressed well. His lumbar incision continued to heal. Serial MRI brains and inflammatory markers were reassuring. He weaned off his EVD and went home to complete a 6-week course of antibiotics. Upon completion of his antibiotics, he returned for a clinic visit; he exhibited no interim fevers or wound issues; cranial imaging documented no evidence of a residual or recurrent subdural empyema.Conclusion:Intracranial subdural empyema may occur after wound complications from detethering surgery despite early initiation of broad-spectrum antibiotics. Possible etiology may be local wound infection that seeds the subdural space and travels to the cranium, leading to meningitis and subdural empyema. Such a scenario should prompt surveillance imaging of the head as undiagnosed subdural empyema may lead to devastating consequences.

Rapidly Developing Subdural Empyema in an Adult with Sinusitis- A Neurosurgical Threat Alert!

Sinonasal inflammatory disorders usually have an innocuous clinical course; however, rarely they can affect the orbits, underlying bones, adjacent veins and the intracranial structures. Intracranial extension is the most dangerous complication of these disorders. The commonest form of intracranial involvement is subdural empyema with bacterial sinusitis being its leading cause. We present a rare case of rhinosinusitis that, within a few hours progressed into a large subdural empyema with severe mass effect and midline shift. The case highlights the importance of having a high index of clinical suspicion and low threshold for imaging in cases of sinusitis that present with subtle neurological signs and symptoms. We emphasize on the role of imaging in optimal management of these cases. The imaging helps in identification of catastrophic neurological complications early in the course of disease and thus guides the treatment approach.

Complications of Frontal Sinusitis

Background: Despite the modern antibiotherapies applied in the practice of otorhinolaryngology, complications of frontal sinusitis are still considered a serious life threatening disease and still causing serious neurological sequelae. Aim: The purpose of this study is to evaluate epidemiology, clinical features and management of the frontal sinusitis’s complications. Study Design: Retrospective study. Methods: 45 patients with osseous, orbital or intracranial complications of frontal sinusitis admitted to our department from 2002 to 2016 were evaluated. The diagnoses were determined based on anamnesis, anterior rhinoscopy, and CT scans with coronal and axial projections. Results: In our study, the average age was 25, 7 (range: 11-75), most patients were male (33/45). The symptoms were: frontal headache in 89%, facial pain in 60% and palpebral edema in 56% and forehead swelling in 36%. Fever was found in 33%. Anterior rhinoscopy showed the presence of purulent discharge in the middle meatus in 18 patients, severe septal deviation in 8 patients and hypertrophic turbinate in 5 patients. 16 patients had osteomyelitis and subperiosteal abscess of the frontal bone, 12 had palpebral inflammatory edema, 9 had orbital cellulitis, 4 had periorbital cellulitis, 2 had epidural empyema, 1 has subdural empyema and 1 has frontal cerebral abscess. 23 patients were managed surgically. Most patients (91%) recovered to premorbid state without neurological sequelae. Conclusion: Complications of frontal sinusitis are rare, but can be dangerous and responsible of severe neurological and orbital sequelae. The early diagnosis and the multidisciplinary management is fundamental in terms of control of the disease.

Finegoldia magna Causing Brain Abscess with Subdural Empyema: Case Report

A 29-year-old female presented with a brain abscess with subdural empyema in the left parafalcine region caused by Finegoldia magna. There was a partial clinical response to surgery and antibiotic therapy. An acute enfarctus developed after abscess drainage surgery in occipital lobe. We think that infarction developed due to transtentorial herniation and with the mass effect of brain abscess. F magna may be detected in many cases like soft tissue infections, septic arthritis, osteomyelitis, endocarditis and necrotizing pneumonia. Actually this is the first report of brain abscess in which F magna was found upon bacterial culture.

Meningitis Caused by Salmonella Newport in a Five-Year-Old Child.

Salmonella Newport is a Gram-negative bacillus belonging to the Enterobacteria family and the nontyphi Salmonella (NTS), usually related to gastroenteritis. Main difference between NTS and Salmonella typhi is that the last one evolves to an invasive disease easier than NTS. These can progress to bacteremias in around 5% of cases and secondary focuses can appear occasionally, as in meningitis. An infection of the central nervous system is uncommon, considering its incidence in 0.6–8% of the cases; most of them are described in developing countries and mainly in childhood, especially neonates. Bacterial meningitis by NTS mostly affects immunosuppressed people in Europe. Prognosis is adverse, with a 50% mortality rate, mainly due to complications of infection: hydrocephalus, ventriculitis, abscesses, subdural empyema, or stroke. Choice antibiotic treatments are cefotaxime, ceftriaxone, or ceftazidime. The aim of this paper is to present a case of meningitis caused by Salmonella Newport diagnosed in a five-year-old girl living in a rural area of the province of Ourense (Spain), with favorable evolution and without neurological disorders.