Intracranial emergencies related to the ear
S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague in ENT Head & Neck Emergencies, 2018
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
Neurology and Non-Traumatic Spinal Imaging
Gareth Lewis, Hiten Patel, Sachin Modi, Shahid Hussain in On Call Radiology, 2015
Subdural empyema refers to a focal infection located within the dura and arachnoid mater. Both cerebral abscess and subdural empyema share similar aetiologies and can complicate each other. Causes include direct spread from adjacent structures (such as sinusitis, mastoiditis and dental infection), haematogenous spread, complications of neurosurgery and meningitis, although haematogenous spread is less commonly seen in subdural empyema as opposed to cerebral abscess. Symptoms and signs most commonly include headache, fever, focal neurology and seizures, with the nature of focal neurological signs depending on lesion location and degree of mass effect. An associated elevation of inflammatory markers can inform the diagnosis; however, its absence should not dissuade from this. Risk factors for haematological spread include IV drug use, bacterial endocarditis, systemic sepsis, chronic lung infection and bronchiectasis, and left to right shunts. Early diagnosis via imaging is vital; this has helped to decrease the once high mortality rate, although this is still estimated at approximately 5–15%. In cases of established abscess or empyema, treatment involves surgical excision and drainage in addition to antibiotic therapy.
Cranial Neurosurgery
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
Subdural empyema refers to an infective collection in the subdural space. This may develop as a result of sinusitis, mastoiditis or meningitis, and can complicate trauma or surgery. Figure43.12 shows a subdural empyema associated with osteomyelitis of the frontal bone and associated scalp swelling (Pott’s puffy tumour). In empyema, pus will generally collect in the parafalcine region and over the convexity, triggering inflammation and thrombosis in the cortical veins, which helps to explain the high mortality of 8-12%. Presentation mimics that of meningitis and cerebral abscess; typical CT appearances are of hypodense or isodense subdural collection, with contrast enhancement at the margins, and a degree of swelling and midline shift. The empyema may be difficult to visualise especially on non-contrast CT. LP should not be performed given the risk of herniation.
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.