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).
- 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.
- 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