Subdural Empyema Clinical Presentation

Updated: Nov 27, 2017
  • Author: Segun Toyin Dawodu, JD, MD, MS, MBA, LLM, FAAPMR, FAANEM; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Presentation

History

A patient with subdural empyema could present with any of the following symptoms:

  • Fever - Temperature above 38°C (100.5°F)

  • Headache - Initially focal and later generalized

  • Recent history (< 2 wk) of sinusitis, [1] otitis media, mastoiditis, meningitis, cranial surgery or trauma, sinus surgery, or pulmonary infection

  • Confusion, drowsiness, stupor, or coma

  • Hemiparesis or hemiplegia

  • Seizure - Focal or generalized

  • Nausea or vomiting

  • Blurred vision (amblyopia)

  • Speech difficulty (dysphasia)

  • History of intracerebral abscess (recent or in the past)

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Physical

A patient with subdural empyema may show some of the following signs:

  • Mental status changes - Confusion, drowsiness, stupor, and coma

  • Meningismus or meningeal signs

  • Hemiparesis or hemisensory deficits

  • Aphasia or dysarthria

  • Seizure

  • Sinus tenderness, swelling, or inflammation

  • Papilledema and other features of increased intracranial pressure, such as nausea/vomiting, mental status changes, and gait disturbance

  • Homonymous hemianopsia

  • Palsies of cranial nerves III, V, or VI, especially if the abscess is near a petrous portion of the temporal bone, causing facial pain and lateral rectus muscle weakness

  • Fixed, dilated pupil on the ipsilateral side due to compression of cranial nerve III

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Causes

The most common cause is extension from paranasal sinusitis, especially from the frontal and ethmoidal sinuses. It could also arise as a complication of otitis media, mastoiditis, septicemia, subdural hematoma, [2] cranial trauma or surgery, or recent sinus surgery; by spread or extension from an intracerebral abscess; by hematogenous spread from pulmonary sources; or from septic thrombosis of cranial veins. Common causative organisms are anaerobes, aerobic streptococci, staphylococci, Haemophilus influenzae,Streptococcus pneumoniae, and other gram-negative bacilli.

  • Paranasal sinusitis -Staphylococcus aureus, alpha-hemolytic streptococci, anaerobic streptococci, Bacteroides species, Enterobacteriaceae

  • Otitis media, mastoiditis - Alpha-hemolytic streptococci, Pseudomonas aeruginosa, Bacteroides species, S aureus

  • Trauma, postsurgical infection -S aureus,Staphylococcus epidermidis, Enterobacteriaceae

  • Pulmonary spread -S pneumoniae,Klebsiella pneumoniae

  • Meningitis (infant or child) -S pneumoniae,H influenzae,Escherichia coli,Neisseria meningitidis

  • Neonates - Enterobacteriaceae, group B streptococci, Listeria monocytogenes

  • Others include hematogenous spread from skin postsurgery (eg, abdominal surgery). Spread from a focus of tuberculosis infection could also occur. A case of subdural empyema developing after infection with Plasmodium falciparum malaria.

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