Subdural empyema differential diagnosis
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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 must be differentiated from subdural hematoma, brain abscess, bacterial meningitis, viral encephalitis, epidural abscess, and cerebral thrombophlebitis.
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][2]
- 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
- ↑ 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.
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.