Subdural empyema natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, [ | If left untreated, subdural empyema frequently evolves into severe [[fever]], [[headache]], [nausea]], [[vomiting]], [[seizures]], [[coma]], and subsequent mortality. Complications to subdural empyema include [[status epilepticus]], neurological deficits, and [[thrombosis]]. Prognosis is generally good with [[antimicrobial]] thearpy. | ||
==Natural History== | ==Natural History== | ||
Subdural empyema is considered a [[neurosurgery|neurosurgical]] emergency. If left untreated, subdural empyema frequently evolves into severe [[fever]], [[headache]], [nausea]], [[vomiting]], [[seizures]], [[coma]], and subsequent mortality. | Subdural empyema is considered a [[neurosurgery|neurosurgical]] emergency. If left untreated, subdural empyema frequently evolves into severe [[fever]], [[headache]], [[nausea]], [[vomiting]], [[seizures]], [[coma]], and subsequent mortality. | ||
==Complications== | ==Complications== | ||
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==Prognosis== | ==Prognosis== | ||
The outcome is dependent on:<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> | Prognosis is generally good with [[antimicrobial]] thearpy. The outcome is dependent on:<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> | ||
*Preoperative level of consciousness | *Preoperative level of consciousness | ||
*Commencement of treatment | *Commencement of treatment | ||
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*Presenting with [[encephalopathy]] or [[coma]] | *Presenting with [[encephalopathy]] or [[coma]] | ||
*Younger than 10 years or elderly | *Younger than 10 years or elderly | ||
* | *Delayed commencement of [[antibiotics]] | ||
*[[Burr hole]] placement | *[[Burr hole]] placement | ||
*Sterile cultures | *Sterile cultures | ||
Revision as of 19:09, 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
If left untreated, subdural empyema frequently evolves into severe fever, headache, [nausea]], vomiting, seizures, coma, and subsequent mortality. Complications to subdural empyema include status epilepticus, neurological deficits, and thrombosis. Prognosis is generally good with antimicrobial thearpy.
Natural History
Subdural empyema is considered a neurosurgical emergency. If left untreated, subdural empyema frequently evolves into severe fever, headache, nausea, vomiting, seizures, coma, and subsequent mortality.
Complications
Complications to subdural empyema include:[1]
- Status epilepticus
- Neurological deficits
- Thrombosis
- Cerebritis
- Cerebral edema
- Cerebral infarction
- Hydrocephalus
- Osteomyelitis
- Damage to the bridging veins
Prognosis
Prognosis is generally good with antimicrobial thearpy. The outcome is dependent on:[1]
- Preoperative level of consciousness
- Commencement of treatment
- Treatment aggressiveness
- Disease progression
Patient education is imperative as failure to follow antibiotic therapy will adversely affect the outcome of the treatment. Identified prognostic factors associated with subdural empyema include:[1]
Unfavorable Prognostic Factors
- Presenting with encephalopathy or coma
- Younger than 10 years or elderly
- Delayed commencement of antibiotics
- Burr hole placement
- Sterile cultures
Favorable Prognostic Factors
- Craniotomy
- Early treatment
- Young age (optimal between 10-20 years)
- Patient presents awake, alert and oriented
- Source of infection: paranasal sinuses
- Aerobic Streptococci isolated in culture
- Aerobic Streptococci as single pathogen