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__NOTOC__
__NOTOC__
{{Subdural empyema}}
{{Subdural empyema}}
{{CMG}}; {{AE}} {{JS}}
{{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 will depend 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
*progress of the disease
*Disease progression
There may be identified some prognostic factors associated with subdural empyema: <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>


<div style="border-radius: 0 0 0 0; height: 30px; line-height: 30px; width: 385px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Unfavorable Prognostic Factors'''
'''Unfavorable Prognostic Factors'''
</font>
*Presentation with [[encephalopathy]] or [[coma]]
</div>
*Age: younger than 10 years or elderly
<div style="border-radius: 0 0 0 0; height: 30px; line-height: 30px; width: 385px; background: #4479BA;">
*Delayed commencement of [[antibiotics]]
<font color="#FFF">
*[[Burr hole]] placement
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Presenting with encephalopathy or coma'''
*Sterile cultures
</font>
</div>
<div style="border-radius: 0 0 0 0; height: 30px; line-height: 30px; width: 385px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Younger than 10 years or elderly'''
</font>
</div>
<div style="border-radius: 0 0 0 0; height: 30px; line-height: 30px; width: 385px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Late start of antibiotics'''
</font>
</div>
<div style="border-radius: 0 0 0 0; height: 30px; line-height: 30px; width: 385px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Sterile cultures'''
</font>
</div>


<div style="border-radius: 0 0 0 0; height: 30px; line-height: 30px; width: 385px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Favorable Prognostic Factors'''
'''Favorable Prognostic Factors'''
</font>
*[[Craniotomy]]
</div>
*Early treatment
<div style="border-radius: 0 0 0 0; height: 30px; line-height: 30px; width: 385px; background: #4479BA;">
*Young age (optimal between 10-20 years)
<font color="#FFF">
*Patient presents awake, alert and oriented
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Craniotomy instead of burr holes as surgical procedure'''
*Source of [[infection]]: [[paranasal sinuses]]
</font>
*[[Aerobic]] [[Streptococci]] isolated in culture
</div>
*[[Aerobic]] [[Streptococci]] as single pathogen
<div style="border-radius: 0 0 0 0; height: 30px; line-height: 30px; width: 385px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Early treatment'''
</font>
</div>
<div style="border-radius: 0 0 0 0; height: 30px; line-height: 30px; width: 385px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Young age (optimal between 10-20 years)'''
</font>
</div>
<div style="border-radius: 0 0 0 0; height: 30px; line-height: 30px; width: 385px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Patient presents awake, alert and oriented'''
</font>
</div>
<div style="border-radius: 0 0 0 0; height: 30px; line-height: 30px; width: 385px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Source of infection: paranasal sinuses'''
</font>
</div>
<div style="border-radius: 0 0 0 0; height: 30px; line-height: 30px; width: 385px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Aerobic streptococci isolated in culture'''
</font>
</div>
<div style="border-radius: 0 0 0 0; height: 30px; line-height: 30px; width: 385px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Aerobic streptococci as single pathogen'''
</font>
</div>


==References==
==References==
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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]

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.



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