Subdural Empyema Research Articles

Pediatric subdural empyema as a complication of meningitis: could CSF protein/CSF glucose ratio be used to screen for subdural empyema?

Subdural empyema (SDE) is a rare condition which can appear secondary to meningitis in childhood, especially in infants. This study was planned to evaluate and compare clinical and laboratory features, treatment, and outcome of children with SDE to those with acute bacterial meningitis (ABM) without SDE. The electronic medical files of 266 patients diagnosed with ABM between January 2009 and December 2019 were evaluated. Patients' demographic and clinical features, laboratory results, cranial imaging findings, treatment, and outcomes were recorded. SDE was identified in 10 patients, 3.7% of all diagnosed with meningitis. The etiology of SDE was identified in eight (80%). The most common responsible pathogen was Streptococcus pneumoniae. Cranial imaging was performed between the 2nd and 13th days of admission, and the most common reason of performing cranial imaging was persistence of fever. Two patients were healed with 4-6 weeks of antibiotic treatment without surgery, eight (80%) needed surgical intervention.Conclusion: The clinical signs and symptoms of SDE may be subtle. If the fever persists or focal neurological findings are seen during the treatment of bacterial meningitis, SDE should be suspected. Furthermore, patients with ABM who are determined to have a protein-to-glucose ratio in the cerebrospinal fluid above 4.65 should be carefully monitored for SDE development. What is known: • Subdural empyema may develop subsequently to meningitis, especially in the infant age group in whom very little is known in terms of disease characteristics. • Delay in diagnosis and treatment can cause long-term neurologic sequelae and mortality. What is new: • Persistence or relapse of fever during the treatment of acute meningitis is an important warning sign for SDE even if there are no other symptoms. • Children with subdural empyema secondary to bacterial meningitis have higher protein-to-glucose ratio in the CSF, and a threshold of ˃ 4.65 was determined to demonstrate 100% sensitivity and 50.7% specificity.

A Case Report : Massive Subdural Empyema Following Ventriculo-Peritoneal Shunt Placement in Child Patient

Background: Subdural empyema is a critical neurosurgical condition that arise from neurosurgical procedures, trauma, meningitis, sinusitis, or otogenic infection. Reported mortality rates vary from 4.4% to 24%. Ventriculoperitoneal (VP) shunt placement is one of the most common procedures and reported rates for shunt infections are relatively high. However, their association with subdural empyema is rare. Case Report: One years old boy who presented with fever, lethargy, and inability to walk was admitted to the hospital. He was undergone Vp-shunt 1 month ago because of hydrocephalus. At the time of admission, the child was alert, had a moderate right hemiparesis, and a macrocephalic appearance. An emergency CT scan showed well-circumscribed subdural empyema. Discussion: A craniotomy was performed, then thick fibrous capsule underlying the dura mater was encountered, finally the pus was totally removed. Postoperatively, he was fully alert with a marked motoric improvement. Diplococus gram positive was found. The patient was given appropriate antibiotic treatment for 3 weeks periode. Conclusion: Subdural empyema is an unusual complication of a VP-shunt. Although rare in children, it is still a neurosurgical problem. The combination of medication and surgery treatment in Subdural empyema resulted in a good response.

Immediate replacement of bone flap after craniotomy for empyema in children.

Optimal management of the bone flap after craniotomy for intracranial infection has not been well defined in the pediatric population. This study reviewed the outcomes of a single Canadian center where immediate replacement of the bone flap was standard practice. This is a retrospective study of all patients who underwent craniotomies for evacuation of epidural or subdural empyema at a single center from 1982 to 2018. Patients were identified using the prospective surgical database maintained by the Division of Pediatric Neurosurgery at BC Children's Hospital. Primary outcome was treatment failure, defined as reoperation at the site of initial surgery for removal of an infected bone flap or repeat drainage of empyema under the replaced bone flap. Secondary outcome was any reoperation for recurrent infection at any site. Twenty-four patients met the inclusion criteria with a minimum of 3-month follow-up from the index intervention. Treatment failure occurred in four patients (17%), all of whom required repeat surgery for further drainage of pus underlying the bone flap. Mean time to repeat surgery was 13 days. Any reoperation for recurrent infection at any site occurred in three patients. Seven out of 24 patients required a second surgery to evacuate empyema (29.2%). Age, sex, epidural or subdural location, osteomyelitis, and bone flap wash were not associated with the primary outcome of treatment failure. Immediate replacement of the bone flap in the surgical management of pediatric subdural or epidural empyema is reasonable. Replacing the flap at the time of first surgery avoids the morbidity and costs of a subsequent reconstructive operation.

Septic cavernous sinus thrombosis—Case series and review of the literature

Background and PurposeSeptic cavernous sinus thrombosis (CST) is a rare, life-threatening disease with infectious thrombosis causing associated complications resulting in high morbidity and mortality. We report a series of CST patients with assessment of arterial and intracranial complications. MethodsWe used the radiology database from a large, academic tertiary care center to collect all patients treated with CST between 2002 and 2019. Patient demographics, source of infection, treatment course and outcomes were evaluated. A review of the recent literature was also performed for similar reported complications from CST. Results14 patients with CST treated during this time period were assessed. Of the 14 patients, 1 patient died. 7 patients had unilateral narrowing of ICA while 3 patients had bilateral narrowing. The ICA narrowing was reversible in 10/12 patients and improvement but persistent narrowing in one patient. One patient had an infectious pseudo aneurysm that was treated by coiling. Extension of thrombosis to the transverse- sigmoid sinuses and internal jugular vein were seen in 3 patients. Three patients had subdural empyema which was treated surgically. ConclusionThe prognosis of CST has improved with advancement in treatment, but complications are not infrequent.

Giant chronic calcified subdural empyema: a case report

BackgroundChronic calcified subdural empyema is an exceedingly rare central nervous system infection with a handful of cases published to date. Reported cases presented with nonspecific clinical signs and symptoms. The duration between the initial onset of symptoms and diagnosis can vary drastically from a few years to up to 46 years. Although there are known predisposing causes, the initial source of infection can sometimes be difficult to identify.Case presentationOur patient was a 39-year-old Ethiopian man who presented with left-side body weakness of 6 years’ duration with worsening of symptoms of 6 months’ duration. He had no history of trauma, meningitis, or previous surgery. The results of routine laboratory tests were normal. The diagnosis was made by computed tomography and magnetic resonance imaging and was confirmed by surgery. Frontoparietal craniotomy was performed, and evacuation of non-foul-smelling collection was done. The patient was reoperated for tension pneumocephalus 48 hours after the initial surgery. He died 10 days later.ConclusionThis is a rare case of a giant chronic calcified subdural empyema with no known preceding history of trauma or infection.

Arachnoid cyst with bony erosion of the posterior frontal sinus wall as cause of a subdural empyema after pansinusitis

Intracranial arachnoid cysts (AC) can lead to a bony thinning of the surrounding skull. We present a young man, in whom a frontal AC has caused a thinning of the frontal calvaria and of the posterior wall of the frontal sinus. This bony vulnerability allowed a frontal sinusitis to spread intracranially and finally led to a subdural empyema with neurological deterioration. The treatment consisted of an emergency craniotomy with evacuation of the empyema and appropriate antibiotic treatment of the causing pathogen (Streptococcus intermedius).

Posterior Fossa Subdural Empyema. A Severe and Usually Late Diagnosed Complication

Posterior Fossa Subdural Empyema. A Severe and Usually Late Diagnosed Complication

Unusual subdural empyema in a homeless patient diagnosed by molecular approach: a case report

BackgroundWe report a case of subdural empyema in a homeless patient caused by Bartonella quintana. B. quintana is a facultative intracellular bacteria for which bacterial growth is fastidious. The molecular biology approach has been a real help in establishing the diagnosis.Case reportA 59-years old homeless patient, with a history of chronic alcohol abuse, was brought to the emergency department with a massive subdural empyema. Extensive microbiological evaluation didn’t reveal any pathogen in the pus collected before antibiotic treatment. B. quintana was detected in the pus from the empyema using a 16S rRNA-based PCR. Histology of intraoperative samples was consistent with the diagnosis and a serological assay was positive. The patient responded well to a treatment that included craniectomy with drainage of the loculated pus, total removal of the infected capsule and a combination of antibiotics.ConclusionThis unique case of B. quintana-related empyema illustrates the risk of secondary infection of subdural hematoma with B. quintana since such infections have recently reemerged, predominantly among the homeless populations. Patients with subdural empyema in at-risk populations should be systematically evaluated for B. quintana with an appropriate diagnostic approach involving molecular biology.

Complications of sinusitis: An 80-case series from the ENT and neurosurgery departments of the Fann university hospital center of Dakar, Senegal

IntroductionLocoregional complications of sinusitis are dominated by oculo-orbital and/or cranioencephalic manifestations that may be life-threatening or jeopardize functional prognosis. The aim of this study was to report epidemiological, diagnostic and therapeutic aspects. Materials and methodsA retrospective study included inpatients managed for sinusitis complications in the ENT and neurosurgery departments of the Fann university hospital center in Dakar, Senegal between January 1, 2005 and December 31, 2016. ResultsIn all, 80 files were collected. Mean age was 18.5 years, with male predominance. Mean time to treatment was 18.2 days. Cranio-encephalic complications were the most frequent (54 cases; 67.5%): mainly subdural empyema (30 cases) and brain abscess (10 cases). Seventeen patients (21.25%) had oculo-orbital complications: mainly orbital cellulitis (52.9%) and preseptal cellulitis (29.4%). Nine patients (11.25%) had both cranioencephalic and oculo-orbital complications. Acute sinusitis (82.5%) was the main cause of complications. 52.5% of patients showed pansinus involvement. Medical treatment consisted in broad-spectrum antibiotic therapy combining third-generation cephalosporins, metronidazole and gentamycin in cranio-encephalic complications and clavulanic acid and metronidazole in oculo-orbital complications. Thirty-four patients (42.5%) underwent surgical sinus drainage. Neurosurgical drainage was performed in 35 cases (43.75%). Post-treatment course was marked by 6.25% mortality (5 cases) and 16.25% sequelae. ConclusionWith 6.25% mortality and a high rate of functional sequelae, complications of sinusitis are a serious concern in our region. Improving prognosis requires earlier management and better coordination between health professionals.

Morphological characteristics of infected subdural hematoma: Comparison with images of chronic subdural hematoma

ObjectivesInfected subdural hematoma (ISH) is a rare type of subdural empyema, with fewer than 50 cases reported to date. Its radiological features have not been adequately described, making diagnosis challenging. At our institution, two adults presented with ISH, which exhibited a characteristic shape on preoperative imaging. Patients and methodsThis study examined ISH cases and chronic subdural hematoma (CSH) cases that underwent surgery at the Ishikawa Prefectural Central Hospital between January 2016 and March 2018. To distinguish ISH from CSH, we focused on three specific radiological features: the biconvex shape of the hematoma, presence of a high-density region at the lower end of the hematoma on plain computed tomography (CT), and presence of a hyper-intense signal within the hematoma on diffusion weighted imaging (DWI). ResultsWe analyzed 30 ISH (current and previously reported) and 102 CSH cases in our study. We found no statistically significant associations between the hematoma type (ISH or CSH) and the presence of a high-density region at the lower end of the hematoma on plain CT (p = 0.13) or the presence of hyperintensity in the hematoma on DWI (p = 1.00). Conversely, a statistically significant association was found between the hematoma type and the biconvex shape of the hematoma (p < 0.01). ConclusionThese results suggest that the shape of the hematoma on imaging provides valuable information that can be used to differentiate ISH from CSH and optimize therapeutic approaches.

A Rare Case of Achromobacter Species Subdural Empyema and Brain Abscess in an Adult Patient with Hematologic Malignancy.

A Rare Case of Achromobacter Species Subdural Empyema and Brain Abscess in an Adult Patient with Hematologic Malignancy.

Complications of Otitis Media and Sinusitis Caused by Streptococcus anginosus Group Organisms in Children.

The Streptococcus anginosus group (SAG, S. anginosus, S. intermedius and S. constellatus) are often associated with severe disease and abscess formation. In our institution, we observed an apparent increase in frequency of intraorbital and intracranial infections resulting from SAG at Texas Children's Hospital. We undertook a retrospective review to describe the frequency and clinical features of these infections. We reviewed the database of the microbiology laboratory at Texas Children's Hospital from 2011 to 2018 for SAG-positive cultures. Cases included were those associated with (1) either otitis media or sinusitis and (2) Pott's puffy tumor, orbital abscesses, mastoiditis, epidural abscesses, subdural empyema, brain parenchymal abscesses or dural enhancement by imaging. The number of overall diagnoses were determined using diagnostic codes and used to estimate the proportion of disease caused by SAG. Ninety-five cases were identified meeting inclusion criteria. The median age of patients was 11.4 years, and 75.8% were previously healthy. S. intermedius was most commonly isolated (80%) followed by S. constellatus (12.6%) and S. anginosus (7.4%); 50.5% of cases were polymicrobial. Among polymicrobial cases, Staphylococcus aureus was most frequently isolated. All patients underwent surgical intervention. 8.4% of patients experienced persistent neurologic deficits. We observed a significant increase in disease incidence during the study period; in addition, the overall proportion of all intracranial infections caused by SAG increased. Complications of otitis media and sinusitis caused by SAG are associated with substantial morbidity. These infections are becoming increasingly common at our center although the precise reason for this temporal trend is unclear.

Neuronavigation-Guided Endoscopic Endonasal Drainage of Pediatric Anterior Cranial Base Epidural and Subdural Empyema

In children, epidural and/or subdural intracranial empyema can complicate frontal sinusitis or pansinusitis. The standard transcranial approach used to treat epidural or subdural empyema has many drawbacks, but these can be avoided with an endoscopic expanded endonasal approach (EEA). To support the feasibility and advantages of this approach, we report the successful drainage through endoscopic EEA of a bifrontal empyema caused by an intracranial extension of pansinusitis. Our case and the ones previously reported in the literature establish well that endoscopic EEA offers several advantages over the standard craniotomy. Hence, EEA should be considered as an alternative to the transcranial approach when surgically draining anterior skull base empyema resulting from pansinusitis in children.

Study of clinicoradiological profile and surgically managed 41 cases of Intracranial infections in a tertiary care institute of north Kerala

Aims: The aim of our study was to present the last 3 years case series of intracranial infections, their major clinical manifestation, radiological distribution and surgical management Background: Intracranial infections are serious and life-threatening medical conditions. The spectrum of intracranial infections includes meningitis, encephalitis, ventriculitis to cerebritis/brain abscess and subdural empyema. Methods: We included 41 patients in our studies out of 45 total cases between 2017(Jan) to 2020(May). Patients information were found from department records and operative register. These patients were confirmed after surgical procedures. In our studies, 11 patients were female and 30 patients were male. The mean age distribution was 7month to 67 years. Out of 41 patients, 33 had intracerebral abscesses (21 solitary abscesses and 12 having multiple abscesses) and 8 had subdural empyemas. All patients underwent craniotomy and some craniectomy as surgical procedures followed by an antibiotic regimen average of 4-6 weeks including at least 2weeks injectable based on culture or empirical. Results: Our results showing more predominant in the male gender and most age group involved were third and fourth decade. Majority of cases no definite infectious agents were identified which constitute about 56%. Fungus and tubercular causes constitute 2.4% and 9.7%. The most common lobe involved was the temporal lobe and the majority of patients underwent craniotomy with complete/partial capsule excision. Predominate clinical manifestations were headache(78%), fever(53.6%), Nausea/Vomiting(29.2%), Neurological deficits(19.5%), Seizure(19.5%). Different location of intracranial infections are as follows Solitary brain abscess in 21%, multiple brain abscess in 12% and subdural empyema in 19.5%. Following surgery, 63.4% were complete symptomatic free and 24.3% clinically improved and death in 12.1% Conclusion: Surgical treatment is the gold standard treatment available for brain abscess and craniotomy still holds the best method to address brain abscess and in particular to developing countries like India in terms of feasibility and cost-effectiveness.

A Giant Calcified Subdural Empyema, a Complication of Ventriculo Peritoneal Shunt: Surgical Management and Revue of Literature

Subdural empyema is not a usual complication of ventriculo peritoneal shunt and the discovery of his calcified form is much exceptional in young adults. We report the case of a female patient of 17 years old carrying a shunt since 16 years who was received for retro auricular suppuration facing the intra ventricular drain and whom cerebral CT-Scan shows a right hemispheric calcified empyema. A large craniotomy was realized in the same time than an external ventricular drain. Evolution was marked by minor right body motor troubles and seizures. Difficulties we have faced during the management are a reminder about morbidity due to the insertion of a ventriculo peritoneal shunt and the need of and long term follow up for the carriers.

Streptococcus equi subsp. equi meningitis, septicemia and subdural empyema in a child

Streptococcus equi subsp. equi is a group C β-hemolytic streptococcus, and is an invasive pathogen with a very restricted host, causing the equine infection known as 'strangles'. It is a poor colonizer in horses, preferentially causing invasion and infection, compared with its ancestor Streptococcus equi subsp. zooepidemicus, which is considered an opportunistic commensal of the equine upper respiratory tract. In humans, S. equi subsp. equi causes invasive infections in immunocompromised hosts, often following close contact with horses. Such infections are associated with a high mortality, as well as a poor neurological outcome in survivors. Beta-lactam antimicrobials form the mainstay of treatment, while neurosurgical intervention is occasionally required. We present the case of a 13-year old boy with systemic lupus erythematosus being treated with hydroxychloroquine, who presented with S. equi subsp. equi meningitis and sepsis after contact with a sick pony. Although he recovered fully following eight weeks of intravenous ceftriaxone and oral rifampin, the clinical course was complicated by subdural empyema requiring neurosurgical evacuation.

Intracranial Subdural Empyema – A Mini Review

Intracranial Subdural Empyema – A Mini Review

Intracranial Subdural Empyema and Brain Abscess Following A Minor-Trauma Induced Chronic Subdural Hematoma

Intracranial Subdural Empyema and Brain Abscess Following A Minor-Trauma Induced Chronic Subdural Hematoma

Etiology and Surgical outcome of chronic Subdural hematoma at Tertiary Care Hospital.

Objectives: To determine etiology and management outcome among patients presenting with chronic subdural hematoma at tertiary care Hospital. Study Design: Cross Sectional. Setting: Department of neurosurgery, Liaquat University Hospital, Hyderabad/Jamshoro. Period: One year from 2015 to 2016. Material &amp; Methods: All the patients with diagnosis of unilateral chronic subdural hematoma, and both male and female gender were included in this study. CT scan and other relevant laboratory investigations were done. All the patients underwent treatment of burr hole evacuation after taken informed consent. Antibiotics were given to all the patients pre- and post-operatively. All the subjects underwent CT scan for the evaluation of hematoma cavity. Patients were discharged generally following 1-week and were followed at outpatients department for 1-month, 3-months and 3-months, respectively. All the patients were assessed according to Glasgow Outcome Scale. Results: Over a period of one year; total thirty patients were selected, most of them were in the 6th and 7th decades of their lives and males were in majority 25(83%). Sixteen patients had a history of minor head injury, eleven patients had no obvious cause and one patient had chronic subdural hematoma secondary to over shunting. According to complications; intracerebral bleed was among 2(6%) cases and Pneumocephalus was in 2(6%) cases, followed by subdural empyema, acute subdural hematoma, extra dural hematoma, penetration into brain via drain catheter, C.S.F leakage and dysphasia were found in one patient, in each case, respectively. Almost every patient recovered and survival rate was 28(93%), while only two patients died. Conclusion: It was concluded that patients showed best outcome (93% survival rate) according to Glasgow Outcome Scale, after burr hole evacuation management. Head injury due to road traffic accident was the most common etiology and burr hole evacuation was the best treatment option for chronic subdural hematoma.

Meningococcal meningitis complicated by subdural empyema and epiduritis in an infant

Subdural empyema is a rare but terrible complication of meningococcal meningitis in children, which can be fatal. The article describes a clinical case of meningococcal meningitis, complicated by subdural empyema and epiduritis, in a three-year-old child. The development of complications was manifested by a new wave of fever, bulging of a bregmatic fontanelle and an increase in the inflammatory markers in the blood, as well as the development of neutrophilic pleocytosis after normalization of the cellular composition of the cerebrospinal fluid. The child was diagnosed on the basis of magnetic resonance imaging of the brain and spinal cord. A longterm antibiotic therapy was effective, and the surgery was not required. The development of such complications should be assumed in all cases of a prolonged course of meningitis, accompanied by an increase in the level of inflammatory markers in the blood, even in the absence of the classic symptoms of subdural empyema.