Subdural empyema natural history, complications and prognosis
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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