Subdural empyema differential diagnosis: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
The clinical features presented by a patient with subdural empyema, such as: [[fever]], [[headache]], focal neurological signs, [[seizures]] and altered mental status, are common to other pathologic conditions: <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><ref>{{Cite book | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages = }}</ref> | The clinical features presented by a patient with subdural empyema, such as: [[fever]], [[headache]], focal neurological signs, [[seizures]] and altered mental status, are common to other pathologic conditions: <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><ref>{{Cite book | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages = }}</ref> | ||
*[[Subdural hematoma]] - accumulation of blood in the [[subdural space]], which frequently surges in the presence of trauma. It may cause an increase of [[intracranial pressure]] causing compression and damage | *[[Subdural hematoma]] - accumulation of [[blood]] in the [[subdural space]], which frequently surges in the presence of trauma. It may cause an increase of [[intracranial pressure]] causing compression and damage to the [[brain]]. The acute form of this condition is considered a [[medical emergency]]. | ||
*[[Brain abscess]] - an [[abscess]] in the [[brain]] caused by the [[inflammation]] and accumulation of [[infected]] material from local or remote infectious areas of the body. The infectious agent may also be introduced as a result of head trauma or neurological procedures. | *[[Brain abscess]] - an [[abscess]] in the [[brain]] caused by the [[inflammation]] and accumulation of [[infected]] material from local or remote infectious areas of the body. The infectious agent may also be introduced as a result of head trauma or neurological procedures. | ||
*[[Bacterial meningitis]] - [[inflammation]] of the [[meninges]] which may develop in the setting of an [[infection]] ([[ | *[[Bacterial meningitis]] - [[inflammation]] of the [[meninges]] which may develop in the setting of an [[infection]] ([[bacteria]], [[viruses]], [[fungi]] or other organisms), physical injury, [[cancer]] or certain drugs. It may have an indolent evolution, resolving on its own, or may present as an rapidly evolving [[inflammation]], causing neurologic damage and potentially death. | ||
*[[Viral encephalitis]] - acute [[inflammation]] of the [[brain]], caused by a [[viral infection]]. It may complicate into severe [[brain]] damage as the inflamed [[brain]] pushes against the [[skull]], potentially leading to death. | *[[Viral encephalitis]] - acute [[inflammation]] of the [[brain]], caused by a [[viral infection]]. It may complicate into severe [[brain]] damage as the inflamed [[brain]] pushes against the [[skull]], potentially leading to death. | ||
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*[[Acute disseminated encephalomyelitis]] - acute neurologic disease of the [[central nervous system]] characterized by scattered foci of [[demyelination]] and perivenular [[inflammation]], which may occur without precipitant, or develop after [[infection]] or [[vaccination]]. | *[[Acute disseminated encephalomyelitis]] - acute neurologic disease of the [[central nervous system]] characterized by scattered foci of [[demyelination]] and perivenular [[inflammation]], which may occur without precipitant, or develop after [[infection]] or [[vaccination]]. | ||
These conditions may be distinguished from subdural empyema by their clinical findings, lumbar puncture results, brain imaging tests and laboratory studies. | These conditions may be distinguished from subdural empyema by their clinical findings, [[lumbar puncture]] results, brain imaging tests and laboratory studies. | ||
==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]
Overview
Subdural empyema, also referred to as subdural abscess, pachymeningitis interna and circumscript meningitis, is a life-threatening infection.[1] It consists of a localised collection of 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 and neurosurgical emergency.[2]
Differential Diagnosis
The clinical features presented by a patient with subdural empyema, such as: fever, headache, focal neurological signs, seizures and altered mental status, are common to other pathologic conditions: [1][3]
- Subdural hematoma - accumulation of blood in the subdural space, which frequently surges in the presence of trauma. It may cause an increase of intracranial pressure causing compression and damage to the brain. The acute form of this condition is considered a medical emergency.
- Brain abscess - an abscess in the brain caused by the inflammation and accumulation of infected material from local or remote infectious areas of the body. The infectious agent may also be introduced as a result of head trauma or neurological procedures.
- Bacterial meningitis - inflammation of the meninges which may develop in the setting of an infection (bacteria, viruses, fungi or other organisms), physical injury, cancer or certain drugs. It may have an indolent evolution, resolving on its own, or may present as an rapidly evolving inflammation, causing neurologic damage and potentially death.
- Viral encephalitis - acute inflammation of the brain, caused by a viral infection. It may complicate into severe brain damage as the inflamed brain pushes against the skull, potentially leading to death.
- Epidural abscess - an abscess in the epidural space, between the vertebrae and the dura mater of the spinal canal.
- Cerebral thrombophlebitis - inflammation of a cerebral vein, related to a blood clot or thrombus.
- Superior sagittal sinus thrombosis - form of thrombosis affecting the dural venous sinuses, which drain blood from the brain.
- Acute disseminated encephalomyelitis - acute neurologic disease of the central nervous system characterized by scattered foci of demyelination and perivenular inflammation, which may occur without precipitant, or develop after infection or vaccination.
These conditions may be distinguished from subdural empyema by their clinical findings, lumbar puncture results, brain imaging tests and laboratory studies.
References
- ↑ 1.0 1.1 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.
- ↑ Greenlee JE (2003). "Subdural Empyema". Curr Treat Options Neurol. 5 (1): 13–22. PMID 12521560.
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.