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Subdural and epidural empyema: diagnostic and therapeutic problems
P B McIntyre1, P S Lavercombe, R J Kemp
1Department of Microbiology, Mater Misericordiae Hospital, South Brisbane, QLD.
The Medical Journal of Australia
|May 20, 1991
Summary
Subdural and epidural empyema, often linked to sinusitis, presents a diagnostic challenge. Early surgical intervention and antibiotics are crucial for survival, as delayed treatment increases mortality risk.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Radiology
Background:
- Subdural and epidural empyema are rare but serious intracranial infections.
- Prompt diagnosis and treatment are critical for patient outcomes.
Observation:
- A 10-year review identified 14 cases of subdural and epidural empyema.
- The paranasal sinuses were the most common source (8/14 cases), with Streptococcus milleri as the primary pathogen.
- Otic origin cases were more readily considered for intracranial collection in differential diagnosis.
Findings:
- Misdiagnosis as meningitis or viral infection was common (8/13 cases).
- Initial computed tomography (CT) scans were not always diagnostic.
- Delayed surgical drainage was associated with all three deaths in the series.
Implications:
- Subdural and epidural empyema require high clinical suspicion, especially with sinusitis.
- While CT imaging has improved, it's not consistently diagnostic.
- Aggressive antimicrobial therapy and prompt surgical intervention are essential to reduce morbidity and mortality.