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)