Subdural Empyema Follow-up

  • Author: Segun T Dawodu, MD, JD, MBA, FAAPMR, FAANEM, CIME, DipMI(RCSed); Chief Editor: Karen L Roos, MD   more...
 
Updated: Jul 14, 2011
 

Further Inpatient Care

  • Recurrence of subdural empyema requires immediate surgical evacuation. If a burr hole was the initial surgical procedure, a craniotomy flap should be considered.
  • Complications such as seizures and subdural effusion may require more aggressive treatment modalities.
  • Assess and treat residual neurological deficits. Inpatient rehabilitation (either subacute or acute) may be necessary.
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Further Outpatient Care

  • Outpatient follow-up by the treating medical, surgical, and infectious disease teams is required.
  • A decision needs to be made concerning whether to continue antiseizure prophylaxis. An EEG may be needed to rule out an epileptic focus.
  • Outpatient rehabilitation for physical therapy, occupational therapy, and speech therapy may be needed.
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Inpatient & Outpatient Medications

  • Intravenous antibiotics for a total period of 3-6 weeks can be administered on either an inpatient or outpatient basis.
  • Antiepileptic medication may be indicated.
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Transfer

  • Transfer to appropriate facilities for medical, surgical, and rehabilitative interventions.
  • Complete, adequate transfer notes with results of all tests and discussion among the physicians are helpful to the receiving institution.
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Complications

  • Seizures
  • Cavernous sinus thrombosis from septic thrombosis of adjacent cerebral veins
  • Increased intracranial pressure
  • Hydrocephalus from compressed cerebrum resulting in interference with CSF flow
  • Cerebral edema from compressed cerebrum leading to interference with cerebral blood flow
  • Cerebral infarction
  • Cranial osteomyelitis, primarily in adjacent cranial bones
  • Residual neurological deficits (eg, hemiparesis, aphasia)
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Prognosis

The mortality rate gradually is decreasing secondary to more timely diagnosis and intervention (eg, antibiotics, surgical drainage).

Unfavorable prognostic factors

  • Encephalopathy or coma at the time of presentation
  • Elderly or younger than 10 years
  • Delay in starting antibiotics
  • Sterile cultures

Favorable prognostic factors

  • Craniotomy as surgical modality (rather than burr holes)
  • Early treatment (surgery and antibiotics)
  • Young age (10-20 y is optimal)
  • Patient alert, awake, and oriented at the time of presentation
  • Paranasal sinus as source of initial infection
  • Isolation of aerobic streptococci in the culture
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Patient Education

Education should emphasize compliance with medication. Urge patients to follow the advice and instructions of rehabilitation programs. The following should be emphasized:

  • The need to complete the full course of antibiotics
  • Regular intake of antiseizure medication, if prescribed
  • A helmet to protect the area of craniotomy
  • Home exercise program

For excellent patient education resources, visit eMedicine's Brain and Nervous System Center, Infections Center, and Public Health Center. Also, see eMedicine's patient education articles Brain Infection and Antibiotics.

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Contributor Information and Disclosures
Author

Segun T Dawodu, MD, JD, MBA, FAAPMR, FAANEM, CIME, DipMI(RCSed)  Associate Professor of Rehabilitation Medicine and Interventional Pain Medicine, Albany Medical College

Segun T Dawodu, MD, JD, MBA, FAAPMR, FAANEM, CIME, DipMI(RCSed) is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American College of Sports Medicine, American Medical Association, American Medical Informatics Association, Association of Academic Physiatrists, International Society of Physical and Rehabilitation Medicine, and Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Coauthor(s)

Nicholas Lorenzo, MD  Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants

Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and American College of Physician Executives

Disclosure: Nothing to disclose.

Specialty Editor Board

Edward L Hogan, MD  Professor, Department of Neurology, Medical College of Georgia; Emeritus Professor and Chair, Department of Neurology, Medical University of South Carolina

Edward L Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Neurological Association, American Society for Biochemistry and Molecular Biology, Phi Beta Kappa, Sigma Xi, Society for Neuroscience, and Southern Clinical Neurological Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Florian P Thomas, MD, MA, PhD, Drmed  Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Director, Neuropathy Association Center of Excellence, Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University School of Medicine

Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Neurological Association, American Paraplegia Society, Consortium of Multiple Sclerosis Centers, and National Multiple Sclerosis Society

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Karen L Roos, MD  John and Nancy Nelson Professor of Neurology, Professor of Neurological Surgery, Department of Neurology, Indiana University School of Medicine

Karen L Roos, MD is a member of the following medical societies: American Academy of Neurology and American Neurological Association

Disclosure: Nothing to disclose.

References

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  2. Chen CY, Huang CC, Chang YC. Subdural empyema in 10 infants: US characteristics and clinical correlates. Radiology. Jun 1998;207(3):609-17. [Medline].

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  4. Greenlee JE. Subdural empyema. In: Mandell GL, ed. Principles and Practice of Infectious Diseases. Vol 1. 4th ed. New York: Churchill;1994:900-903.

  5. Feuerman T, Wackym PA, Gade GF. Craniotomy improves outcome in subdural empyema. Surg Neurol. Aug 1989;32(2):105-10. [Medline].

  6. Sanford JP. Guide to antimicrobial therapy. Bethseda MD: Uniformed Services University Health Sciences. 1993;3.

  7. Delgado Tapia JA, Galera Lopez J, Santiago Martin J, et al. Subdural empyema due to Mycoplasma hominis after a cesarean section under spinal anesthesia. Rev Esp Anestesiol Reanim. 2005;52(4):239-242. [Medline].

  8. Dwarakanath S, Suri A, Mahapatra AK. Spontaneous subdural empyema in falciparum malaria: a case study. J Vector Borne Dis. Sep-Dec 2004;41(3-4):80-2. [Medline].

  9. Foerster BR, Thurnher MM, Malani PN, Petrou M, Carets-Zumelzu F, Sundgren PC. Intracranial infections: clinical and imaging characteristics. Acta Radiologica. October 2007;48(8):875-93. [Medline].

  10. Hall WA, Truwit CL. The surgical management of infections involving the cerebrum. Neurosurgery. February 2008;62 Supplement 2:519-30. [Medline].

  11. Krauss WE, McCormick PC. Infections of the dural spaces. Neurosurg Clin N Am. Apr 1992;3(2):421-33. [Medline].

  12. Mauser HW, Van Houwelingen HC, Tulleken CA. Factors affecting the outcome in subdural empyema. J Neurol Neurosurg Psychiatry. Sep 1987;50(9):1136-41. [Medline].

  13. Migirov L, Eyal A, Kronenberg J. Intracranial complications following mastoidectomy. Pediatr Neurosurg. Sep-Oct 2004;40(5):226-9. [Medline].

  14. .

  15. [Best Evidence] Moorthy RK, Rajshekhar V. Intracranial Abscess. Neurosurg Focus. 2008;24 (6):E3.

 
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MRI scan of a subdural empyema in the left parietal area.
CT scan of a subdural empyema in the left temporal/parietal area.
 
 
 
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