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{{Subdural empyema}}
{{Subdural empyema}}
{{CMG}}; {{AE}} {{JS}}
{{CMG}} {{AE}} {{JS}}; {{AG}}


==Overview==
==Overview==
Subdural empyema, also referred to as [[subdural abscess]], [[pachymeningitis interna]] and [[circumscript meningitis]], is a life-threatening [[infection]].<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 localised collection of [[pus|purulent]] material, usually unilateral, between the [[dura mater]] and the [[arachnoid mater]] and 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>
Physical examination of patients with subdural empyema is usually remarkable for [[fever]], [[face pain]], and [[altered mental status]].
The diagnosis of subdural empyema should be suspected, when a patient presents with a history of [[sinusitis]] and recent [[CNS]] signs and/or symptoms.<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><ref>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref>
Symptoms include those referable to the source of the [[infection]]. In addition, most patients are [[febrile]], with [[headache]] and [[neck stiffness]], and, if untreated, may develop focal neurologic signs, [[lethargy]], and [[coma]].


==Physical Examination==
==Physical Examination==
On the physical examination of a patient with subdural empyema, the physician might find: <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>
===Appearance of the Patient===
Patients with acute subdural empyema appear in poor condition, often appearing [[lethargic]], [[vomiting]], and [[convulsing]].
 
===Vital signs===
*[[Fever]]
 
===HEENT===
*[[Facial pain]] / [swelling]]
*[[Meningismus]]
*[[Sinusitis]]
*[[Mastoiditis]]
*[[Otitis]]
*[[Papilledema]]
**[[Homonymous hemianopsia]]
*Fixed [[mydriasis]] on the ipsilateral side (from compression of 3rd [[cranial nerve]])
 
 
===Neck===
*[[Neck stiffness]]
 
===Neuromuscular===
*[[Altered mental status]]
*[[Coma]]
*[[Stupor]]
*[[Confusion]]
*[[Drowsiness]],
*[[Hemiparesis]] or hemisensory deficits
*[[Aphasia]]
*[[Seizures]]
*[[Gait disturbances]]
*[[cranial nerve disease|Palsies]] of 3rd, 5th and 6th [[cranial nerves]]


*[[meningismus]]
*mental status changes, such as [[confusion]], [[drowsiness]], [[stupor]] and [[coma]]
*[[hemiparesis]] or hemisensory deficits
*[[aphasia]] or [[dysarthria]]
*[[seizures]]
*[[sinus]] tenderness, swelling or [[inflammation]]
*[[papilledema]], with other manifestations of [[increased intracranial pressure]], such as:
**[[nausea]]/[[vomiting]]
**mental status changes
**[[gait disturbances]]
*homonymous [[hemianopsia]]
*[[cranial nerve disease|palsies]] of 3rd, 5th and 6th [[cranial nerves]], particularly in the event of an [[abscess]] located near the [[petrous portion]] of the [[temporal bone]]
*fixed [[mydriasis]] on the ipsilateral side, from compression of 3rd [[cranial nerve]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Needs content]]
 
[[Category:Infectious disease]]
[[Category:Infectious disease]]


{{WH}}
{{WH}}
{{WS}}
{{WS}}

Revision as of 20:10, 4 December 2015

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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]

Overview

Physical examination of patients with subdural empyema is usually remarkable for fever, face pain, and altered mental status.

Physical Examination

Appearance of the Patient

Patients with acute subdural empyema appear in poor condition, often appearing lethargic, vomiting, and convulsing.

Vital signs

HEENT


Neck

Neuromuscular


References

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