Clinical Review of Cerebral Subdural Empyema.

Kim, Sang Cheol; Kang, Jae Kyu; Kwan, Koh Young; Do, Jong Oung

Original Article

Journal of Korean Neurosurgical Society 1999;28(9): 1337-1343.

Sang Cheol Kim, Jae Kyu Kang, Koh Young Kwan, Jong Oung Do

Department of Neurosurgery, National Medical Center, Seoul, Korea.

ABSTRACT

OBJECTIVE
The purpose of this study was to review our experience with subdural empyema. Clinical presentation, methods of diagnosis, results of microbiological tests, types of therapy, and outcome of patients are presented and compared with previous reports.
METHODS
The study consists of 10 patients with subdural empyema treated from January 1988 to December 1997. Clinical records and radiologic studies were reviewed retrospectively. The patient population consisted of 8 men and 2 women, whose ages ranged from 12 to 65 years(mean 49.1 years). Diagnosis of subdural empyema was confirmed with contrastenhanced CT scanning or Gadoliniumenhanced MR imaging. Seven patients received surgical treatments and three patients were treated with a multiple antibiotics only.
RESULTS
The subdural empyema have been found to occur most commonly after paranasal sinusitis and postoperative infection in four cases respectively, otitis media and mastoiditis in one case respectively. The organism were found to be staphylococci in three cases, streptococci in two cases, anaerobic streptococci in one case, sterile in one case, and unknown in three cases. Relative frequency of signs and symptoms revealed fever in eight cases, headache in seven cases, vomiting in five cases, hemiparesis in three cases, and epilepsy in two cases. The outcome was revealed good in eight cases, poor in two cases.
CONCLUSION
Although subdural empyema is considered a rare condition, it constitutes between 13 and 23 per cent of all intracranial infectin. It usually presents as a fulminant clinical picture and rapid neurological deterioration. In this sense, it constitutes a true neurosurgical emergency. Diagnosis of subdural empyema is best made by either CT with contrast or by MRI. Both of these tests are also helpful in establishing the presence or absence of sinusitis. Subsequently, surgery along with antibiotics help to lower mortality rate. Antibiotics therapy should be selected according to final culture results and continued for 4 to 6 weeks. The general consensus is in favour of early drainage to reduce the mortality and clinical deterioration. In our study, the overall mortality rate was 0%, and 20% of patients had neurological deficiencies at the time of discharge from the hospital. It is very important for clinician to detect this condition early to keep low mortality and morbidity.

Key Words: Subdural empyema; Brain CT; MRI; Early drainage