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Neurological Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
CT scanning: This will determine whether a space-occupying lesion is present. Patients with subdural empyema may have a ‘normal’ scan initially, with changes only becoming apparent on repeated scanning 24–48 hours later.
Complications of Rhinosinusitis
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Subdural empyema is one of the most common intracranial complications. The brain is more exposed as the infection is beyond the dura mater and allows thrombosis of the local venous network. Serious neurological injury can occur if not treated rapidly and aggressively with combined medical treatment and neurosurgical drainage to decompress the brain and evacuate empyema. Subdural empyemas present with meningeal irritation and neurological signs such as seizures or focal deficits.
Intracranial emergencies related to the ear
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
Paramita Baruah, Duncan Bowyer
A subdural empyema is a collection of pus that develops between the dura and arachnoid layers. It is a rare complication of otitis media and can develop by direct extension or thrombophlebitis. Infection spreads readily once it enters the subdural layer because the anatomical barriers are limited. The clinical picture deteriorates rapidly, in keeping with an expanding intracranial mass. The patient is toxic and progresses quickly from severe headache, fever, vomiting and malaise to falling consciousness level and focal neurological signs. Confirmation of the diagnosis is made with neuroimaging (Figure 19.3). Treatment is emergency neurosurgical drainage and intravenous antibiotics (initially driven by local empirical policy and subsequently by culture sensitivities). Management of the underlying ear disease is addressed only once the patient has been stabilized. The condition has a high mortality rate (13% with subdural empyema compared to 0% with epidural abscess in a series of 31 children), and residual neurological deficits are common.11
Towards improved outcome in children treated surgically for spontaneous intracranial suppuration in South Wales
Published in British Journal of Neurosurgery, 2023
Milan Makwana, Joseph P. Merola, Imran Bhatti, Chirag K. Patel, Paul A. Leach
Several series report fever as a common symptom of intracranial suppuration with reported incidence as high as 82%;14 however, this seems variable as conflicting reports also show incidence of fever as low as 15%.3 In our series, only 44% presented with fever, albeit all of those did have intracranial infection, it suggests that this may not be a reliable indicator of intracranial infection. Seizures occurred in 9/10 (90%) of the patients with subdural empyema which is in keeping with the natural history of this condition.15 We found that raised inflammatory markers were not always a reliable indication of intracranial suppuration.
Intravenous fosfomycin for the treatment of patients with central nervous system infections: evaluation of the published evidence
Published in Expert Review of Anti-infective Therapy, 2020
Katerina G Tsegka, Georgios L Voulgaris, Margarita Kyriakidou, Matthew E Falagas
CNS infections require immediate and well targeted treatment, as neurologic and systematic complications and mortality of these infections are high [2]. Empiric treatment depends on epidemiological factors and antibiotic resistance patterns of the usual pathogens [3]. In some cases, such as subdural empyema and brain abscesses, antibiotic treatment is combined with neurosurgical drainage. The antibiotics of choice vary and most of the times combination therapy is required [1].
Paediatric brain abscesses: a single centre experience
Published in British Journal of Neurosurgery, 2019
Samuel Hall, Shirley Yadu, Benjamin Gaastra, Nijaguna Mathad, Owen Sparrow, Ryan Waters, Aabir Chakraborty, Vassilios Tsitouras
Inclusion criteria were patients who were less than 18 years of age with a radiologically confirmed intra-parenchymal abscess. Those with isolated subdural empyema, extradural abscess, or an unknown abscess location were excluded from the study.