What Is Subdural Empyema?
Subdural empyema is a serious medical condition that involves the accumulation of pus in the space between the outermost layer of the brain (the dura mater) and the thin layer of tissue that covers the brain (the arachnoid mater). This condition is usually caused by a bacterial infection that spreads from another part of the body, such as the sinuses or the middle ear, to the space around the brain.
Subdural empyema is a rare condition, but it is considered a medical emergency. Without prompt treatment, it can lead to serious complications, such as brain abscesses, meningitis, and permanent brain damage.
Diagnosis of subdural empyema typically involves a combination of imaging tests, such as a CT scan or an MRI, and laboratory tests to identify the type of bacteria causing the infection. Treatment typically involves surgical drainage of the pus and a course of antibiotics to control the infection. In some cases, a craniotomy (surgery to remove a portion of the skull) may be necessary to access the infected area and remove the pus.
The outlook for subdural empyema depends on a variety of factors, including the severity of the infection, the age and overall health of the patient, and how quickly treatment is initiated. In general, the earlier the condition is diagnosed and treated, the better the chances for a full recovery. However, even with prompt treatment, some patients may experience long-term complications, such as neurological deficits or seizures.
What are the symptoms of subdural empyema?
The symptoms of subdural empyema can vary depending on the severity and location of the infection. Some common symptoms may include:-
- Fever
- Headache
- Confusion
- Seizures
- Weakness
- Difficulty moving or speaking
- Nausea and vomiting
- Sensitivity to light
- Loss of consciousness or coma
These symptoms can develop quickly, and the condition can progress rapidly, making it a medical emergency. If you or someone you know is experiencing any of these symptoms, seek medical attention immediately.
It is important to note that some of these symptoms can be similar to other medical conditions, such as meningitis or brain abscess, so a thorough evaluation by a medical professional is necessary to make an accurate diagnosis.
What Is The Diagnostic Test For Subdural Empyema?
The diagnosis of subdural empyema typically involves a combination of imaging tests and laboratory tests. The following are some of the diagnostic tests used to diagnose subdural empyema:-
CT scan:- A computed tomography (CT) scan is typically the first test done to evaluate for subdural empyema. A CT scan can show the presence of fluid or pus in the space between the brain and the skull.
MRI:- Magnetic resonance imaging (MRI) may be used to get a more detailed picture of the brain and identify the extent of the infection.
Lumbar puncture:- A lumbar puncture, also known as a spinal tap, may be done to analyze the cerebrospinal fluid (CSF) for signs of infection.
Blood tests:- Blood tests may be done to look for signs of infection, such as an elevated white blood cell count.
Culture and sensitivity testing:- A sample of the pus or fluid from the infection site may be sent for laboratory testing to identify the type of bacteria causing the infection and determine the best course of antibiotic treatment.
Biopsy:- A biopsy of the infected tissue may be necessary in cases where the diagnosis is unclear or the infection is not responding to treatment
What Is Subdural Empyema Classification?
It can be classified based on the location of the infection, the type of bacteria causing the infection, and the underlying cause. The classification of subdural empyema is important for determining the appropriate treatment and predicting the outcome of the condition.
The classification of subdural empyema is important for determining the appropriate treatment, as the type of bacteria causing the infection and the underlying cause can affect the choice of antibiotics and the need for surgical intervention.
A. Based on the location of the infection, subdural empyema can be classified as follows:-
Cranial subdural empyema:- This type of subdural empyema involves the space between the dura mater and the arachnoid mater of the brain.
Spinal subdural empyema:- This type of subdural empyema involves the space between the dura mater and the arachnoid mater of the spinal cord.
B. Based on the type of bacteria causing the infection, subdural empyema can be classified as follows:-
Aerobic subdural empyema:- This type of subdural empyema is caused by aerobic bacteria, such as Streptococcus pneumoniae or Staphylococcus aureus.
Anaerobic subdural empyema:- This type of subdural empyema is caused by anaerobic bacteria, such as Bacteroides fragilis or Fusobacterium nucleatum.
Mixed subdural empyema:- This type of subdural empyema is caused by a mixture of aerobic and anaerobic bacteria.
C. Based on the underlying cause, subdural empyema can be classified as follows:-
Primary subdural empyema:- This type of subdural empyema occurs spontaneously and without an identifiable source of infection.
Secondary subdural empyema:- This type of subdural empyema occurs as a complication of another infection, such as sinusitis or otitis media.
How Is Subdural Empyema Treated?
Treatment typically involves a combination of antibiotics and surgical drainage of the infected fluid or pus. The specific treatment approach may depend on the severity of the infection, the location of the infection, and the underlying cause.
Antibiotics:- Antibiotics are used to treat the underlying bacterial infection. The choice of antibiotics will depend on the type of bacteria causing the infection and its susceptibility to certain antibiotics. Intravenous antibiotics are typically used for several weeks to ensure that the infection is fully cleared.
Surgical drainage:- Surgical drainage is necessary to remove the infected fluid or pus from the subdural space. This may involve a craniotomy, which is a surgical procedure to remove a portion of the skull to access the infected area, or a burr hole drainage, which involves making a small hole in the skull to drain the pus.
Supportive care:- Supportive care may be necessary to manage symptoms and prevent complications. This may include pain management, management of seizures or other neurological symptoms, and monitoring of vital signs.
Treatment of underlying conditions:- In cases where subdural empyema is secondary to another infection, such as sinusitis or otitis media, treatment of the underlying condition may be necessary to prevent recurrence.
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Brant and Helms’ Fundamentals of Diagnostic Radiology