Subdural empyema natural history, complications and prognosis: Difference between revisions

Jump to navigation Jump to search
← Older edit
VisualWikitext
Anthony Gallo (talk | contribs)
Bureaucrats, bureaucrats, nocaptcha, Administrators
6,611 edits
No edit summary
WikiBot (talk | contribs)
Bots, Bureaucrats, bureaucrats, interwiki, nocaptcha, Administrators
57,550 edits
m Changes made per Mahshid's request
 
(10 intermediate revisions by 2 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Subdural empyema}}
{{Subdural empyema}}
{{CMG}}; {{AE}} {{JS}}
{{CMG}} {{AE}} {{JS}}; {{AG}}


==Overview==
==Overview==
Subdural empyema, also referred to as [[subdural abscess]], [[pachymeningitis interna]] and [[circumscript meningitis]], is a life-threatening [[infection]].<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref> It consists of a localised collection of [[pus|purulent]] material, usually unilateral, between the [[dura mater]] and the [[arachnoid mater]] and accounts for about 15-22% of the reported focal intracranial [[infections]].  The [[empyema]] may develop intracranially (about 95%) or in the [[spinal canal]] (about 5%), and in both cases, it constitutes a [[medical emergency|medical]] and [[surgical emergency|neurosurgical emergency]].<ref name="pmid12521560">{{cite journal| author=Greenlee JE| title=Subdural Empyema. | journal=Curr Treat Options Neurol | year= 2003 | volume= 5 | issue= 1 | pages= 13-22 | pmid=12521560 | doi= | pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12521560  }} </ref>
If left untreated, patients with subdural empyema may develop severe [[fever]], [[headache]], [[nausea]], [[vomiting]], and [[seizures]]. Untreated subdural empyema may also lead to [[coma]] and subsequent [[mortality]]. Complications of subdural empyema include [[status epilepticus]], neurological deficits, and [[thrombosis]]. Prognosis is generally good with [[antimicrobial]] therapy.


==Natural History==
==Natural History==
The subdural empyema may develop from two different conditions, according to the age of the individual. In children, subdural empyema is most frequently a complication of [[meningitis]]  while in adults it's more frequently a complication of [[sinusitis]]  [[otitis]] or [[mastoiditis]].  It may also occur as a complication of head trauma or of a neurosurgical procedure. Depending on the source of [[infection]] the etiologic organism will then be different. Subdural empyema is considered a neurological emergency, because if untreated, it frequently evolves into [[coma]] and death. With early diagnosis and appropriate treatment, it usually resolves without further complications. At presentation, patients usually complain of [[fever]], [[headache]], [[nausea]]/ [[vomiting]], [[neck stiffness]] and [[seizures]].  With clinical suspicion of subdural empyema, broad-spectrum [[antibiotics]] should be initiated, until a more specific diagnosis of the etiological agent is known, at which time, therapy should be directed to that agent.
Subdural empyema is considered a [[neurosurgery|neurosurgical]] emergency. If left untreated, subdural empyema frequently evolves into severe [[fever]], [[headache]], [[nausea]], [[vomiting]], [[seizures]], [[coma]], and subsequent [[mortality]].  


==Complications==
==Complications==
Subdural empyema is a condition which, if not treated appropriately and in a timely manner, can progress into serious complications, that may lead invariably to a fatal outcome. An untreated subdural empyema may evolve into: <ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref>
Complications to subdural empyema include:<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref>
*[[Status epilepticus]]
*[[Status epilepticus]]
*Neurological deficits
*Neurological deficits
*Spreading cortico-venous sinus [[thrombosis]]
*[[Thrombosis]]
*[[Cerebritis]]
*[[Cerebritis]]
*[[Cerebral edema]]
*[[Cerebral edema]]
Line 19: Line 19:
*[[Hydrocephalus]]
*[[Hydrocephalus]]
*[[Osteomyelitis]]
*[[Osteomyelitis]]
*[[Mortality]]
*Damage to the [[bridging veins]]
 
There may also be complications from the treatment of the empyema, such as:
*Damage to the [[bridging veins]] during the [[craniotomy]] procedure to evacuate the empyema.


==Prognosis==
==Prognosis==
The outcome is dependent on:<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref>
Prognosis is generally good with [[antimicrobial]] thearpy. The outcome is dependent on:<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref>
*Preoperative level of consciousness
*Preoperative level of [[consciousness]]
*Start time of the treatment
*Commencement of treatment
*Treatment aggressiveness
*Treatment duration
*Disease progression
*Disease progression


Patient education is imperative as failure to follow the antibiotic therapy will adversely affect the outcome of the treatment. Identified prognostic factors associated with subdural empyema include:<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref>
Patient education is imperative as failure to follow antibiotic therapy will adversely affect the outcome of the treatment. Identified prognostic factors associated with subdural empyema include:<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref>
*Unfavorable Prognostic Factors:
 
#Presenting with encephalopathy or coma
'''Unfavorable Prognostic Factors'''
#Younger than 10 years or elderly
*Presentation with [[encephalopathy]] or [[coma]]
#Late start of antibiotics
*Age: younger than 10 years or elderly
#Sterile cultures
*Delayed commencement of [[antibiotics]]
*Favorable Prognostic Factors:
*[[Burr hole]] placement
#Craniotomy instead of burr holes as surgical procedure
*Sterile cultures
#Early treatment
 
#Young age (optimal between 10-20 years)
'''Favorable Prognostic Factors'''
#Patient presents awake, alert and oriented
*[[Craniotomy]]
#Source of infection: paranasal sinuses
*Early treatment
#Aerobic streptococci isolated in culture
*Young age (optimal between 10-20 years)
#Aerobic streptococci as single pathogen
*Patient presents awake, alert and oriented
*Source of [[infection]]: [[paranasal sinuses]]
*[[Aerobic]] [[Streptococci]] isolated in culture
*[[Aerobic]] [[Streptococci]] as single pathogen


==References==
==References==
Line 50: Line 50:




[[Category:Infectious disease]]
 


{{WH}}
{{WH}}
{{WS}}
{{WS}}

Latest revision as of 18:53, 18 September 2017

Empyema Main Page

Subdural empyema Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Subdural empyema from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Lumbar Puncture

X Ray

CT

MRI

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Subdural empyema natural history, complications and prognosis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Subdural empyema natural history, complications and prognosis

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Subdural empyema natural history, complications and prognosis

CDC on Subdural empyema natural history, complications and prognosis

Subdural empyema natural history, complications and prognosis in the news

Blogs on Subdural empyema natural history, complications and prognosis

Directions to Hospitals Treating Subdural empyema

Risk calculators and risk factors for Subdural empyema natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]; Anthony Gallo, B.S. [3]

Overview

If left untreated, patients with subdural empyema may develop severe fever, headache, nausea, vomiting, and seizures. Untreated subdural empyema may also lead to coma and subsequent mortality. Complications of subdural empyema include status epilepticus, neurological deficits, and thrombosis. Prognosis is generally good with antimicrobial therapy.

Natural History

Subdural empyema is considered a neurosurgical emergency. If left untreated, subdural empyema frequently evolves into severe fever, headache, nausea, vomiting, seizures, coma, and subsequent mortality.

Complications

Complications to subdural empyema include:[1]

Prognosis

Prognosis is generally good with antimicrobial thearpy. The outcome is dependent on:[1]

  • Preoperative level of consciousness
  • Commencement of treatment
  • Treatment duration
  • Disease progression

Patient education is imperative as failure to follow antibiotic therapy will adversely affect the outcome of the treatment. Identified prognostic factors associated with subdural empyema include:[1]

Unfavorable Prognostic Factors

Favorable Prognostic Factors

References

  1. ↑ 1.0 1.1 1.2 Agrawal, Amit; Timothy, Jake; Pandit, Lekha; Shetty, Lathika; Shetty, J.P. (2007). "A Review of Subdural Empyema and Its Management". Infectious Diseases in Clinical Practice. 15 (3): 149–153. doi:10.1097/01.idc.0000269905.67284.c7. ISSN 1056-9103.



Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Subdural_empyema_natural_history,_complications_and_prognosis&oldid=1359816"