Subdural empyema in children--20-year experience in a medical center

Subdural empyema (SDE) is a serious neurological condition in children and adults. Although otorhinolaryngeal infections are regarded as the most important predisposing factors in the literature, this has not been our experience. This study reviewed clinical data on pediatric patients with SDE at our institution over the last 20 years.

Charts of children hospitalized in Mackay Memorial Hospital from 1985 to 2005, with a final diagnosis of SDE were reviewed. Gender, predisposing factors, symptoms and signs, bacteriologic data, diagnostic work-up, treatment procedures, and outcome were collected and analyzed.

In total, 31 patients were enrolled. Twenty seven of them (87.1%) were below the age of one year. The male-to-female ratio was 1.21. Only 3 patients (9.7%) had prior otorhinolaryngeal infections; 6 patients (19.4%) had SDE following head trauma or surgery. The leading clinical manifestations were fever (96.8%), seizure (70.1%), and focal neurological signs (58.1%). The most common pathogens included Streptococcus pneumoniae (16.1%), group B Streptococcus (12.9%), Haemophilus influenzae type b (12.9%), Salmonella spp. (12.9%), Escherichia coli (9.7%) and Pseudomonas aeruginosa (9.7%). Cerebrospinal fluid leukocyte counts and protein levels were usually high and the glucose levels were usually low. SDE was first suspected or found via brain sonography in 9 infants. Nine patients (29.0%) received only medical treatment for SDE. Three patients (9.7%) died--all were infected by S. pneumoniae. Twelve patients (38.7%) recovered without neurological sequelae.

In the past 20 years, most of our cases of pediatric SDE occurred in infancy, and only one-tenth of them had prior otorhinolaryngeal infections. Brain sonography could be a helpful tool for early diagnosis of SDE in infancy.