Subdural Empyema

  • Rare complication of frontal sinusitis, osteomyelitis of the skull, middle ear disease or trauma/surgery
    • As with cerebral abscess, causative organisms are dependent on the source of infection
      • S anginosus and Staphylococcus are most common; S  aureus is associated with traumatic/surgical cases
  • Patients present with severe pain in the face/head; pyrexia; meningisn; altered conscious level; seizures and focal neurological signs (as mass effect ensues)
    • (may also have a history of ear/sinus infection)
  • CT/MRI are the investigations of choice (NOT LP- as not helpful and contraindicated in raised ICP)
  • Management is IV high dose antibiotics (likely including metronidazole and vancomycin; although if gram-negative cover is required, meropenem may be appropriate); and surgical decompression (burr-hole or craniotomy)
  • Mortality varies from 10% (early diagnosis) to 50% (late)

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