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| ==[[Subdural empyema overview|Overview]]== | | ==[[Subdural empyema overview|Overview]]== |
| [[Subdural empyema]], also referred to as ''subdural abscess'', ''pachymeningitis interna'' and ''circumscript meningitis'', is a life-threatening infection, first reported in literature approximately 100 years ago.<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 located collection of [[purulent]] material, usually unilateral, between the [[dura mater]] and the[[arachnoid mater]]. It 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> The intracranial type tends to behave like an expanding mass, causing clinical symptoms, such as [[fever]], [[lethargy]], [[headache]] and neurological deficits. These result from the extrinsic compression of the brain, caused not only from the [[inflammatory]] mass, but also from the [[inflammation]] of the [[brain]] and [[meninges]]. Because the subdural space has no septations, except in areas where arachnoid granulations attach to the dura mater, the subdural empyema tends to speed quickly, until it finds those boundaries.
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| In children, subdural empyema most often happens as a complication of meningitis, while in adults it usually occurs as a complication of sinusitis, otitis media, mastoiditis, trauma or as a complication of neurological procedures.<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> The most common pathogens in the intracranial type are anaerobic and [[microaerophilic]] ''[[streptococci]]'', but others like ''[[Escherichia coli]]'' and ''[[Bacteroides]]'' may be present simultaneously. Spinal subdural empyemas, on the other hand, are almost always caused by[[''streptococci'']] or by ''[[staphylococcus aureus]]''.<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>
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| Classic clinical syndrome includes acute [[fever]], that rapidly progresses into neurological deterioration, which if left untreated will eventually lead to a [[coma]] and death.<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> The diagnostic procedure of choice is the [[MRI]] with [[gadolinium]] enhancement.
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| Since the clinical symptoms might be mild and unspecific initially, the rapid diagnosis and treatment are crucial. The sooner the proper treatment is initiated, the better the recovery will be. The treatment, for almost all causes, requires prompt [[surgical]] drainage and [[antibiotic]] therapy.<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> With treatment, resolution of the [[empyema]] occurs from the dural side, and, if it is complete, a thickened [[dura mater|dura]] may be the only residual finding.
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| ==[[Subdural empyema historical perspective|Historical Perspective]]== | | ==[[Subdural empyema historical perspective|Historical Perspective]]== |
