Subdural Empyema

A rapidly spreading, life-threatening infection caused by accumulation of pus in the space between the membranes surrounding the brain, requiring emergency treatment.

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Surgical Infectious Diseases

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1Overview

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What is this Condition?

Subdural empyema is the accumulation of pus in the narrow space between two of the membranes surrounding the brain (the outer dura and inner arachnoid). Because this space is large and unrestricted, infection can spread rapidly within hours to days; therefore, it is a neurosurgical emergency. The most common cause is sinusitis; middle ear infection, meningitis, head trauma, or surgical procedures may also be responsible. It occurs more frequently in young males. High fever, severe headache, weakness on one side of the body, seizures, and altered consciousness are typical symptoms. Diagnosis is made with contrast-enhanced MRI. Treatment requires emergency surgical drainage and prolonged antibiotic therapy.

Symptoms

High fever and chills

Severe, progressively worsening headache

Weakness on one side of the body or speech disturbance

Seizures

Neck stiffness; altered consciousness, drowsiness, disorientation

Sinusitis symptoms: nasal discharge, facial pain, swelling in the forehead region

Diagnosis Methods

The most valuable diagnostic method is contrast-enhanced MRI; this imaging shows a pus collection with enhancing borders running parallel to the brain surface, and possible complications such as vascular occlusion can be assessed. Blood tests investigate inflammatory markers and the source of infection. Sinuses and ears are also examined to identify the source. Because the condition can progress rapidly, imaging and evaluation are performed without delay.

Treatment Methods

Subdural empyema is an emergency, and it is important to initiate treatment without delay. The primary treatment is surgical drainage of the accumulated pus; this can be performed by opening a wide window in the skull (craniotomy) or, in some cases, through irrigation and drainage via a smaller opening. Surgery is accompanied by intravenous antibiotic therapy, typically lasting 4-6 weeks. The source of infection (for example, sinusitis) is also treated separately. Supportive therapies for seizures and cerebral edema are also applied.

Emergency surgical drainage: The accumulated pus is drained through a window opened in the skull (craniotomy) or, when appropriate, through irrigation and drainage via a smaller opening.

Prolonged intravenous antibiotics: Treatment targeting the responsible microorganisms, typically lasting 4-6 weeks.

Treatment of the infection source: Sources such as sinusitis and middle ear infection are treated separately.

Supportive therapy: Seizure control, cerebral edema management, and close monitoring of the patient's general condition are provided.

Treatment Path

Related Treatments

The procedures and interventions most commonly explored with this condition.

4 links

Lumbar Puncture

Collection of cerebrospinal fluid through a needle in the lower back

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Intracranial Pressure Monitor Placement

Monitor implantation for continuous intracranial pressure monitoring

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External Ventricular Drainage

External Ventricular Drainage procedure

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Endoskopik intraserebral/intraventriküler hematom boşaltımı

Endoskopik intraserebral/intraventriküler hematom boşaltımı procedure

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References

Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023.
Winn HR, ed. Youmans and Winn Neurological Surgery. 6th ed. Elsevier; 2011.
Sekhar LN, Fessler RG, eds. Atlas of Neurosurgical Techniques: Brain. 2nd ed. Thieme; 2015.

This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.

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Subdural Empyema

Surgical Infectious Diseases

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

Related Treatments

Lumbar Puncture

Intracranial Pressure Monitor Placement

External Ventricular Drainage

Endoskopik intraserebral/intraventriküler hematom boşaltımı

References

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Lumbar Puncture

Intracranial Pressure Monitor Placement

External Ventricular Drainage

Endoskopik intraserebral/intraventriküler hematom boşaltımı

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