Subdural empyema

Background

  • Usually complications of sinusitis (especially frontal, ethmoidal, or sphenoidal) or otitis media
    • Other causes include other ear infections, cranial trauma or surgery, or rarely bacteremia
    • In children <5yo, cause is typically bacterial meningitis
  • Typically due to epidural abscess extending into subdural space to cause subdural empyema


Clinical Features

Differential Diagnosis

Intracranial Mass


Evaluation

  • Assess for alternative causes of symptoms (e.g. labs to rule out metabolic process, glucose, infectious workup)
  • MRI brain with contrast
  • Blood cultures
  • Definitive diagnosis by culture of surgical specimens
  • LP NOT helpful and may precipitate herniation
  • In infants, a subdural tap may be diagnostic and may relieve pressure

Management

  • Address airway protection
  • Antibiotics similar to those used for brain abscess: e.g. cefotaxime, ceftriaxone, metronidazole, vancomycin
    • In children, cover also for bacterial meningitis
  • Emergent neurosurgery consult for drainage


Disposition

  • Admit

See Also

External Links

References

Authors:

Claire