Empyema subdural

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Subdural empyema is a volumetric accumulation of pus under the dura mater, which occurs secondarily. Etiology and pathogenesis

    • The most common causative agent is staphylococcus aureus.
    • Inflammation of the paranasal sinuses (especially with frontal sinusitis and ethmoiditis), otitis media and internal, mastoiditis
    • Penetrating TBI or neurosurgical operation, suppuration of subacute or chronic subdural hematoma, post-traumatic osteomyelitis
    • Bacteremia in infectious lesions (most often the lungs)
    • In infants under 5 years of age, the most common underlying cause of subdural empyema is bacterial meningitis (for example, in neonates, meningitis is most commonly caused by Hemophilus influenzae and Gram-negative bacteria)
    • The pathogenesis has common features with a brain abscess.

The clinical picture does not differ significantly from that of a brain abscess.

    • Intoxication syndrome (general serious condition, fever, chills)
    • meningeal syndrome
    • Cerebral symptoms (due to increased ICP)
    • Focal neurological symptoms (depending on location)
    • Depression of consciousness and sometimes psychopathological symptoms (delirium, psychomotor agitation).

Diagnostics

    • Changes in peripheral blood, indicating an inflammatory process
    • Lumbar puncture – pleocytosis (increased content of cellular elements)
    • Subdural puncture for diagnosis in newborns
    • CT and MRI – a zone of reduced density corresponding to localization and volume.

Treatment

    • The main method is surgical in combination with antibiotic therapy.
    • Removal of empyema with subsequent drainage (including the underlying air sinuses to avoid re-development).
    • Conservative treatment (see Brain abscess for details]
    • Antibacterial therapy
    • Measures to reduce intracranial pressure: mannitol (mannitol), furosemide, if necessary, mechanical ventilation in hyperventilation mode
    • Detoxification therapy
    • Symptomatic therapy.

Synonym. Abscess subdural

See also Brain abscess, Subdural hematoma, Bacterial meningitis, Traumatic brain injury ICD. G06.0 Intracranial abscess and granuloma