The Subdural empyema is a suppurating process in the cranial subdural space between the inner surface of the dura and the outer of the arachnoid. About three fourth of the cases are unilateral and the remainder bilateral, usually in the para facial region.
The infection usually gains the entry to the subdural space from the frontal or ethmoid sinus, or less often from the mastoid cells.
The subdural space may also become infected from osteomyelitis or from a brain abscess.
Secondary subdural empyema may also occur from drainage of chronic subdural hematoma.
Symptoms / Signs
- History of chronic sinusitis or otitis with a recent flare up.
- Pain
- Increase in purulent nasal or aural discharge. The illness is severe and progressive.
- Headache, vomiting, fever, depressed sensorial are the first indications of intracranial spread.
- Followed by localizing signs: focal motor seizures, hemiplegia, hemianesthesia, and aphasia.
- Papilledema is present in one half of the patients.
- Stupor or coma rapidly develops.
Investigation
C.S.F analysis
Lumbar puncture possesses a distinct risk if the diagnosis of subdural empyema is being postulated, since it precipitates transtentorial herniation...
Radiological feature of Subdural empyema
CT is usually the first diagnostic test and is usually the only one needed, as patients often go to the theater for discharge.
C.T scan appearance is a crescentric or elliptical hypodense area lying directly below the cranial vault or adjacent to the flax cerebri.
CT
Subdural empathy is usually similar to subdural hematoma in its formation and relationship with sutures and dural reflections. They are usually crescentic, although cluster pockets may appear biconvex. The surrounding membrane that develops highly and uniformly to follow comparative control is common.
MRI
The look on the MRI is similar to that on CT, although the improvement in brightness is easily seen. In addition, the content of the collection will show limited distribution.
MRI is also very sensitive to subdural problems, e.g. cerebritis, cerebral abscess, venous thrombosis.
Treatment
Drainage of pus is the most important part of the treatment.
Successful treatment is predicted for rapid diagnosis, followed by surgical removal of collection and administration of appropriate antibiotics.
Antibiotics.
Subdural empyema vs Epidural abscess
An intracranial epidural abscess is a red mass between dura mater and the skull. Subdural empyema is a reddish tinge between the dura mater and the lower arachnoid mater. Symptoms of an epidural abscess include fever, headache, vomiting, and sometimes fatigue, concentrated neurologic deficiency, fainting, and / or thirst. Symptoms of subdural hemorrhage include fever, vomiting, consciousness, and rapid growth of neurologic symptoms that promote widespread involvement of a single cerebral hemisphere. The diagnosis is made by advanced MRI or, if MRI is not available, advanced CT. Treatment is done with surgical drainage and antibiotics,
Complication
Cranial epidural abscess and subdural hemorrhage are usually complications of sinusitis (especially anterior, ethmoidal, or sphenoidal) or otitis media, but may follow other ear infections, spinal trauma or surgery, or, more commonly, bacterium. Bacteria such as these cause boils in the brain (e.g., Staphylococcus aureus, Bactericides fragile).
Diagnosis
MRI
Diagnosis of epidural tumor or subdural tumor is performed with randomly performed MRI or, if MRI is not available, with advanced CT. Blood and surgical samples are performed aerobically and anaerobically.
Lumbar puncture provides a little useful information and may cause transtentorial brain rot. If an epidural intracranial abscess or subdural epilepsy is suspected (e.g., based on duration of a few days, severe deficits, or risk factors) in patients with brain symptoms, lumbar piercing is prevented until neuroimaging does not involve a large wound.
In infants, subdural tapping may be diagnostic and may reduce stress.
In children under 5 years of age, the most common cause is bacterial meningitis; because pediatric meningitis is now uncommon, a small child’s epilepsy is rare.
The epidural abscess can extend to the lower extremities to cause subdural edema. Both the epidural and subdural lesions may develop into meningitis, cortical venous thrombosis, or brain tumor. The subdural cavity can spread rapidly to cover the entire cerebral hemisphere.
Different Signs and Symptoms between Subdural empyema and Epidural abscess
Fever, headache, fatigue, concentrated neurologic deficits (often indicating subdural hemorrhage when progressive deficits suggest extensive involvement of the cerebral hemisphere), and fainting usually occurs within a few days.
Patients with epidural intracranial tumor may also have sub-periosteal abscess and osteomyelitis of the anterior bone (Pot puffy tumor), and patients with subdural hemorrhage often have meningeal symptoms. In epidural abscess and subdural epilepsy, vomiting is common. Many patients may have papilledema.
Without treatment, coma and death occur rapidly, especially in the subdural cavity.
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