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Subdural Empyema Follow-up

  • Author: Segun Toyin Dawodu, JD, MD, MS, MBA, LLM, FAAPMR, FAANEM; Chief Editor: Niranjan N Singh, MD, DM  more...
 
Updated: Dec 08, 2015
 

Further Outpatient Care

See the list below:

  • 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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Further Inpatient Care

See the list below:

  • 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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Inpatient & Outpatient Medications

See the list below:

  • 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

See the list below:

  • 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

See the list below:

  • 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

See the list below:

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

Favorable prognostic factors

See the list below:

  • 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 eMedicineHealth's Brain and Nervous System Center and Infections Center. Also, see eMedicineHealth's patient education articles Brain Infection and Antibiotics.

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Contributor Information and Disclosures
Author

Segun Toyin Dawodu, JD, MD, MS, MBA, LLM, FAAPMR, FAANEM Attending Interventional Physiatrist, Wellspan Health

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

Disclosure: Nothing to disclose.

Coauthor(s)

Nicholas Lorenzo, MD, MHA, CPE Founding Editor-in-Chief, eMedicine Neurology; Founder and CEO/CMO, PHLT Consultants; Chief Medical Officer, MeMD Inc

Nicholas Lorenzo, MD, MHA, CPE is a member of the following medical societies: Alpha Omega Alpha, American Association for Physician Leadership, American Academy of Neurology

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Florian P Thomas, MD, PhD, Drmed, MA, MS Director, National MS Society Multiple Sclerosis Center; Professor and Director, Clinical Research Unit, Department of Neurology, Adjunct Professor of Physical Therapy, Associate Professor, Institute for Molecular Virology, St Louis University School of Medicine; Editor-in-Chief, Journal of Spinal Cord Medicine

Florian P Thomas, MD, PhD, Drmed, MA, MS is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, American Academy of Neurology, American Neurological Association, Consortium of Multiple Sclerosis Centers, National Multiple Sclerosis Society, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Niranjan N Singh, MD, DM Associate Professor of Neurology, University of Missouri-Columbia School of Medicine

Niranjan N Singh, MD, DM is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Headache Society

Disclosure: Nothing to disclose.

Additional Contributors

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, Society for Neuroscience, American Society for Biochemistry and Molecular Biology, American Academy of Neurology, American Neurological Association, Phi Beta Kappa, Sigma Xi, Southern Clinical Neurological Society

Disclosure: Nothing to disclose.

References
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  15. Placeholder.

  16. 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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