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...
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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.

Further Inpatient Care

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  • 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.

Inpatient & Outpatient Medications

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  • 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.


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.


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)


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

Unfavorable prognostic factors

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

Favorable prognostic factors

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  • 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

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.