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

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__NOTOC__
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{{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==
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 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>


==Prognosis==
'''Unfavorable Prognostic Factors'''
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>
*Presentation with [[encephalopathy]] or [[coma]]
*preoperative level of consciousness
*Age: younger than 10 years or elderly
*start time of the treatment
*Delayed commencement of [[antibiotics]]
*treatment aggressiveness
*[[Burr hole]] placement
*progress of the disease
*Sterile cultures
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>


{| class="wikitable"
'''Favorable Prognostic Factors'''
|style="border-style:solid; border-width: 1px; border-color: #4479BA; text-align:center; width: 350px; background: #A1BCDD; color: white;" | '''Unfavorable Prognostic Factors'''
*[[Craniotomy]]
|-
*Early treatment
|style="border-style:solid; border-width: 1px; border-color: #4479BA; width: 350px; background: #4479BA; color: white;" | &nbsp;&nbsp;▸&nbsp;&nbsp;Presenting with encephalopathy or coma
*Young age (optimal between 10-20 years)
|-
*Patient presents awake, alert and oriented
|style="border-style:solid; border-width: 1px; border-color: #4479BA; width: 350px; background: #4479BA; color: white;" | &nbsp;&nbsp;▸&nbsp;&nbsp;Younger than 10 years or elderly
*Source of [[infection]]: [[paranasal sinuses]]
|-
*[[Aerobic]] [[Streptococci]] isolated in culture
|style="border-style:solid; border-width: 1px; border-color: #4479BA; width: 350px; background: #4479BA; color: white;" | &nbsp;&nbsp;▸&nbsp;&nbsp;Late start of antibiotics
*[[Aerobic]] [[Streptococci]] as single pathogen
|-
|style="border-style:solid; border-width: 1px; border-bottom: 0px; border-color: #4479BA; width: 350px; background: #4479BA; color: white;" | &nbsp;&nbsp;▸&nbsp;&nbsp;Sterile cultures
|-
|style="border-style:solid; border-width: 1px; border-color: #4479BA; text-align:center; color: white; width: 350px; background:#A1BCDD;" | '''Favorable Prognostic Factors'''
|-
|style="border-style:solid; border-width: 1px; border-color: #4479BA; width: 350px; background: #4479BA; color: white;" | &nbsp;&nbsp;▸&nbsp;&nbsp;Craniotomy instead of burr holes as surgical procedure
|-
|style="border-style:solid; border-width: 1px; border-color: #4479BA; width: 350px; background: #4479BA; color: white;" | &nbsp;&nbsp;▸&nbsp;&nbsp;Early treatment
|-
|style="border-style:solid; border-width: 1px; border-color: #4479BA; width: 350px; background: #4479BA; color: white;" | &nbsp;&nbsp;▸&nbsp;&nbsp;Young age (optimal between 10-20 years)
|-
|style="border-style:solid; border-width: 1px; border-color: #4479BA; width: 350px; background: #4479BA; color: white;" | &nbsp;&nbsp;▸&nbsp;&nbsp;Patient presents awake, alert and oriented
|-
|style="border-style:solid; border-width: 1px; border-color: #4479BA; width: 350px; background: #4479BA; color: white;" | &nbsp;&nbsp;▸&nbsp;&nbsp;Source of infection: paranasal sinuses
|-
|style="border-style:solid; border-width: 1px; border-color: #4479BA; width: 350px; background: #4479BA; color: white;" | &nbsp;&nbsp;▸&nbsp;&nbsp;Aerobic streptococci isolated in culture
|-
|style="border-style:solid; border-width: 1px; border-color: #4479BA; width: 350px; background: #4479BA; color: white;" | &nbsp;&nbsp;▸&nbsp;&nbsp;Aerobic streptococci as single pathogen
|}


==References==
==References==
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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]

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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