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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> Following clinical evaluation, proper history taking, physical examinations and laboratory test results, the diagnosis of subdural empyema has to be confirmed by imaging studies.
MRI in the optimal imaging study in the diagnosis of subdural empyema. Findings on MRI suggestive of subdural empyema are similar to those on [[CT scan]], and include a crescentic shape, though collection pockets may appear bi-convex. A surrounding membrane that enhances intensely and uniformly following contrast administration is typically identified and may also demonstrate restricted diffusion.  


==MRI==
==MRI==
[[MRI]] with [[gadolinium]] enhancement is considered the best imaging study for intracranial and spinal subdural empyema, with a [[sensitivity]] of 93%, since it reveals clearly the [[pus]] collections, as well as signs of [[meningitis|meningeal infections]]. The characteristic image of a subdural empyema on an [[MRI]] is a fluid collection surrounded by a contrast-enhancing rim. It is used in emergent situations, with high level os suspicion, with the possibility of diagnosing subdural empyema at a time when symptoms are still [[headache]] and [[fever]], with absent focal neurologic signs. <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 [[diffusion MRI|diffusion-weighted imaging]] method increases the diagnosis preciseness and offers the ability of monitoring [[antibiotic]] therapy. <ref name="Hendaus2013">{{cite journal|last1=Hendaus|first1=Mohammed A.|title=Subdural Empyema in Children|journal=Global Journal of Health Science|volume=5|issue=6|year=2013|issn=1916-9744|doi=10.5539/gjhs.v5n6p54}}</ref> The [[MRI]] should be careful evaluated for the presence of [[epidural abscess]],  [[meningitis]],  [[brain abscess]] and [[cerebral edema]], with the possibility of showing [[sinusitis]], [[otitis]] or [[mastoiditis]]. <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> [[MRI]] imaging studies demonstrate the subdural empyema as a convexity or interhemispheric collection, with a low signal on T1 and a high signal on T2 weighted images.<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>
[[MRI]] with [[gadolinium]] enhancement is considered the optimal imaging study for intracranial and spinal subdural empyema. MRI clearly t reveals clearly the [[pus]] collections, as well as signs of [[meningitis|meningeal infections]]. The characteristic image of a subdural empyema on an [[MRI]] is a fluid collection surrounded by a contrast-enhancing rim. It is used in emergent situations, with high level of suspicion, with the possibility of diagnosing subdural empyema at a time when symptoms are still [[headache]] and [[fever]], with absent focal neurologic signs. <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 [[diffusion MRI|diffusion-weighted imaging]] method increases the diagnosis preciseness and offers the ability of monitoring [[antibiotic]] therapy. <ref name="Hendaus2013">{{cite journal|last1=Hendaus|first1=Mohammed A.|title=Subdural Empyema in Children|journal=Global Journal of Health Science|volume=5|issue=6|year=2013|issn=1916-9744|doi=10.5539/gjhs.v5n6p54}}</ref> The [[MRI]] should be careful evaluated for the presence of [[epidural abscess]],  [[meningitis]],  [[brain abscess]] and [[cerebral edema]], with the possibility of showing [[sinusitis]], [[otitis]] or [[mastoiditis]]. <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> [[MRI]] imaging studies demonstrate the subdural empyema as a convexity or interhemispheric collection, with a low signal on T1 and a high signal on T2 weighted images.<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>





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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

MRI in the optimal imaging study in the diagnosis of subdural empyema. Findings on MRI suggestive of subdural empyema are similar to those on CT scan, and include a crescentic shape, though collection pockets may appear bi-convex. A surrounding membrane that enhances intensely and uniformly following contrast administration is typically identified and may also demonstrate restricted diffusion.

MRI

MRI with gadolinium enhancement is considered the optimal imaging study for intracranial and spinal subdural empyema. MRI clearly t reveals clearly the pus collections, as well as signs of meningeal infections. The characteristic image of a subdural empyema on an MRI is a fluid collection surrounded by a contrast-enhancing rim. It is used in emergent situations, with high level of suspicion, with the possibility of diagnosing subdural empyema at a time when symptoms are still headache and fever, with absent focal neurologic signs. [1] The diffusion-weighted imaging method increases the diagnosis preciseness and offers the ability of monitoring antibiotic therapy. [2] The MRI should be careful evaluated for the presence of epidural abscess, meningitis, brain abscess and cerebral edema, with the possibility of showing sinusitis, otitis or mastoiditis. [1] MRI imaging studies demonstrate the subdural empyema as a convexity or interhemispheric collection, with a low signal on T1 and a high signal on T2 weighted images.[3]


MRI demonstrating extensive subdural collections with rim enhancement and diffusion restriction, consistent with subdural empyema

References

  1. 1.0 1.1 Greenlee JE (2003). "Subdural Empyema". Curr Treat Options Neurol. 5 (1): 13–22. PMID 12521560.
  2. Hendaus, Mohammed A. (2013). "Subdural Empyema in Children". Global Journal of Health Science. 5 (6). doi:10.5539/gjhs.v5n6p54. ISSN 1916-9744.
  3. Agrawal, Amit; Timothy, Jake; Pandit, Lekha; Shetty, Lathika; Shetty, J.P. (2007). "A Review of Subdural Empyema and Its Management". Infectious Diseases in Clinical Practice. 15 (3): 149–153. doi:10.1097/01.idc.0000269905.67284.c7. ISSN 1056-9103.

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