Subdural empyema: Difference between revisions

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__NOTOC__
__NOTOC__
{{Infobox disease|
{{Infobox disease
  Name          = Subdural empyema |
| Name          = Subdural Empyema
  Image          = Subduralempyemaandskinabscess.png |
| Image          = Subduralempyemaandskinabscess.png  
  Caption        = An abscess that has let to an intracranial subdural empyema as seen on CT |
| Caption        = Subdural empyema with skin abscess as seen on CT
}}
}}
'''For patient information, click [[Subdural empyema (patient information)|here]]'''
'''For patient information, click [[Subdural empyema (patient information)|here]].'''


{{Subdural empyema}}
{{Subdural empyema}}
{{CMG}}
{{CMG}} {{AE}} {{JS}}; {{AG}}
 
{{SK}} Circumscript meningitis; Pachymeningitis interna; Purulent pachymeningitis; Subdural abscess; SDE


==[[Subdural empyema overview|Overview]]==
==[[Subdural empyema overview|Overview]]==
[[Subdural empyema]], also referred to as ''subdural abscess'', ''pachymeningitis interna'' and ''circumscript meningitis'', is a life-threatening infection, first reported in literature approximately 100 years ago.<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref> It consists of a located collection of [[purulent]] material, usually unilateral, between the [[dura mater]] and the[[arachnoid mater]]. It accounts for about 15-22% of the reported focal intracranial [[infections]]. The empyema may develop intracranially (about 95%) or in the spinal canal (about 5%), and in both cases, it constitutes a [[Medical emergency|medical]] and [[Surgical emergency|neurosurgical emergency]].<ref name="pmid12521560">{{cite journal| author=Greenlee JE| title=Subdural Empyema. | journal=Curr Treat Options Neurol | year= 2003 | volume= 5 | issue= 1 | pages= 13-22 | pmid=12521560 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12521560  }} </ref> The intracranial type tends to behave like an expanding mass, causing clinical symptoms, such as [[fever]], [[lethargy]], [[headache]] and neurological deficits. These result from the extrinsic compression of the brain, caused not only from the [[inflammatory]] mass, but also from the [[inflammation]] of the [[brain]] and [[meninges]]. Because the subdural space has no septations, except in areas where arachnoid granulations attach to the dura mater, the subdural empyema tends to speed quickly, until it finds those boundaries.
In children, subdural empyema most often happens as a complication of meningitis, while in adults it usually occurs as a complication of sinusitis, otitis media, mastoiditis, trauma or as a complication of neurological procedures.<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref> The most common pathogens in the intracranial type are anaerobic and [[microaerophilic]] ''[[streptococci]]'', but others like ''[[Escherichia coli]]'' and ''[[Bacteroides]]'' may be present simultaneously. Spinal subdural empyemas, on the other hand, are almost always caused by[[''streptococci'']] or by ''[[staphylococcus aureus]]''.<ref name="pmid12521560">{{cite journal| author=Greenlee JE| title=Subdural Empyema. | journal=Curr Treat Options Neurol | year= 2003 | volume= 5 | issue= 1 | pages= 13-22 | pmid=12521560 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12521560  }} </ref>
Classic clinical syndrome includes acute [[fever]], that rapidly progresses into neurological deterioration, which if left untreated will eventually lead to a [[coma]] and death.<ref name="AgrawalTimothy2007">{{cite journal|last1=Agrawal|first1=Amit|last2=Timothy|first2=Jake|last3=Pandit|first3=Lekha|last4=Shetty|first4=Lathika|last5=Shetty|first5=J.P.|title=A Review of Subdural Empyema and Its Management|journal=Infectious Diseases in Clinical Practice|volume=15|issue=3|year=2007|pages=149–153|issn=1056-9103|doi=10.1097/01.idc.0000269905.67284.c7}}</ref> The diagnostic procedure of choice is the [[MRI]] with [[gadolinium]] enhancement.
Since the clinical symptoms might be mild and unspecific initially, the rapid diagnosis and treatment are crucial. The sooner the proper treatment is initiated, the better the recovery will be. The treatment, for almost all causes, requires prompt [[surgical]] drainage and [[antibiotic]] therapy.<ref name="pmid12521560">{{cite journal|author=Greenlee JE| title=Subdural Empyema. | journal=Curr Treat Options Neurol | year= 2003 | volume= 5 | issue= 1 | pages= 13-22 | pmid=12521560 | doi= | pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12521560  }} </ref> With treatment, resolution of the [[empyema]] occurs from the dural side, and, if it is complete, a thickened [[dura mater|dura]] may be the only residual finding.


==[[Subdural empyema historical perspective|Historical Perspective]]==
==[[Subdural empyema historical perspective|Historical Perspective]]==
==[[Subdural empyema classification|Classification]]==


==[[Subdural empyema pathophysiology|Pathophysiology]]==
==[[Subdural empyema pathophysiology|Pathophysiology]]==
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==[[Subdural empyema causes|Causes]]==
==[[Subdural empyema causes|Causes]]==


==[[Subdural empyema differential diagnosis|Differentiating Subdural empyema from other Diseases]]==
==[[Subdural empyema differential diagnosis|Differentiating Subdural Empyema from other diseases]]==


==[[Subdural empyema epidemiology and demographics|Epidemiology and Demographics]]==
==[[Subdural empyema epidemiology and demographics|Epidemiology and Demographics]]==
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==[[Subdural empyema risk factors|Risk Factors]]==
==[[Subdural empyema risk factors|Risk Factors]]==


==[[Subdural empyema natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
==[[Subdural empyema natural history, complications and prognosis|Natural History, Complications, and Prognosis]]==


==Diagnosis==
==Diagnosis==


[[Subdural empyema history and symptoms|History and Symptoms]] | [[Subdural empyema physical examination|Physical Examination]] | [[Subdural empyema laboratory findings|Laboratory Findings]] | [[Subdural empyema electrocardiogram|Electrocardiogram]] | [[Subdural empyema x ray|X Ray]] | [[Subdural empyema CT|CT]] | [[Subdural empyema MRI|MRI]] | [[Subdural empyema other diagnostic studies|Other Diagnostic Studies]]
[[Subdural empyema history and symptoms|History and Symptoms]] | [[Subdural empyema physical examination|Physical Examination]] | [[Subdural empyema laboratory findings|Laboratory Findings]] | [[Subdural empyema lumbar puncture|Lumbar Puncture]] | [[Subdural empyema x ray|X Ray]] | [[Subdural empyema CT|CT]] | [[Subdural empyema MRI|MRI]] | [[Subdural empyema other diagnostic studies|Other Diagnostic Studies]]


==Treatment==
==Treatment==
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[[Subdural empyema case study one|Case #1]]
[[Subdural empyema case study one|Case #1]]


[[Category:Infectious disease]]
 
{{WH}}
[[Category:Neurology]]
{{WS}}

Latest revision as of 18:53, 18 September 2017

Subdural Empyema
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Subdural empyema with skin abscess as seen on CT

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]; Anthony Gallo, B.S. [3]

Synonyms and keywords: Circumscript meningitis; Pachymeningitis interna; Purulent pachymeningitis; Subdural abscess; SDE

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Subdural Empyema from other diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications, and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Lumbar Puncture | X Ray | CT | MRI | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

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Case #1

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