Subdural Empyema Follow-up

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...
  • Print
Follow-up

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.

Next:

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.

Previous
Next:

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.

Previous
Next:

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.

Previous
Next:

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)

Previous
Next:

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

Previous
Next:

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.

Previous