Subdural empyema natural history, complications and prognosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Subdural empyema}} | {{Subdural empyema}} | ||
{{CMG}} | {{CMG}} {{AE}} {{JS}}; {{AG}} | ||
==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== | ==Natural History== | ||
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== | ||
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]] | |||
*Neurological deficits | |||
*[[Thrombosis]] | |||
*[[Cerebritis]] | |||
*[[Cerebral edema]] | |||
*[[Cerebral infarction]] | |||
*[[Hydrocephalus]] | |||
*[[Osteomyelitis]] | |||
*Damage to the [[bridging veins]] | |||
==Prognosis== | ==Prognosis== | ||
The outcome | 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]] | ||
* | *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:<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''' | |||
*Presentation with [[encephalopathy]] or [[coma]] | |||
''' | *Age: younger than 10 years or elderly | ||
*Delayed commencement of [[antibiotics]] | |||
*[[Burr hole]] placement | |||
*Sterile cultures | |||
'''Favorable Prognostic Factors''' | |||
*[[Craniotomy]] | |||
*Early treatment | |||
*Young age (optimal between 10-20 years) | |||
*Patient presents awake, alert and oriented | |||
*Source of [[infection]]: [[paranasal sinuses]] | |||
*[[Aerobic]] [[Streptococci]] isolated in culture | |||
*[[Aerobic]] [[Streptococci]] as single pathogen | |||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 18:53, 18 September 2017
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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]
- Status epilepticus
- Neurological deficits
- Thrombosis
- Cerebritis
- Cerebral edema
- Cerebral infarction
- Hydrocephalus
- Osteomyelitis
- Damage to the bridging veins
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
- Presentation with encephalopathy or coma
- Age: younger than 10 years or elderly
- Delayed commencement of antibiotics
- Burr hole placement
- Sterile cultures
Favorable Prognostic Factors
- Craniotomy
- Early treatment
- Young age (optimal between 10-20 years)
- Patient presents awake, alert and oriented
- Source of infection: paranasal sinuses
- Aerobic Streptococci isolated in culture
- Aerobic Streptococci as single pathogen
References