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Infratentorial subdural empyema: clinical and computerized tomography findings. Report of three cases
B Borovich1, E Johnston, E Spagnuolo
1Department of Neurosurgery, Hospital de Clínicas, Faculty of Medicine, Montevideo, Uruguay.
Abstract:
Infratentorial subdural empyemas are rare. The authors report three cases encountered between 1979 and 1988, representing a 3% incidence among all subdural empyemas. The common source was an ear infection. Clinical presentation encompassed a systemic febrile illness, headaches, and a stiff neck. Only one patient had an inconspicuous focal neurological deficit that suggested a cerebral location. Initial diagnosis was acute meningitis in each case. A lumbar puncture was ordered in all three cases but was actually performed in two without developing tonsillar herniation. Cerebrospinal fluid analysis confirmed the diagnosis of meningitis in one but was normal in the other. Computerized tomography allowed a precise diagnosis and localization of the pathology. All three patients received aggressive antibiotic therapy plus suboccipital craniectomy and aspiration of pus; catheter drainage was performed in two. Cultures were positive in one case and negative in the others. Two patients were cured without sequelae; the third patient was moribund at surgery and died. Although it is known that subdural empyemas may localize in the posterior fossa, only one previous report was found. Infratentorial subdural empyema may sometimes be an unrecognized companion of acute meningitis and is cured with antibiotic therapy alone.
Insights
Infratentorial subdural empyemas, often originating from ear infections, are rare but can mimic meningitis. Prompt diagnosis with CT scans and aggressive treatment, including antibiotics and surgery, can lead to recovery.
Area of Science:
- Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Infratentorial subdural empyemas are uncommon intracranial infections.
- These posterior fossa empyemas represent a small fraction of all subdural empyemas.
- Ear infections are a frequent source of infratentorial subdural empyema.
Purpose of the Study:
- To report on the incidence and clinical characteristics of infratentorial subdural empyemas.
- To highlight diagnostic challenges and treatment outcomes for this rare condition.
- To emphasize the potential association between infratentorial subdural empyema and acute meningitis.
Main Methods:
- Retrospective case series of three patients diagnosed between 1979 and 1988.
- Clinical presentation, diagnostic workup including lumbar puncture and computerized tomography (CT), and treatment modalities were reviewed.
- Surgical intervention involved suboccipital craniectomy and pus aspiration, with catheter drainage in some cases.
Main Results:
- Three cases of infratentorial subdural empyema were identified, constituting 3% of all subdural empyemas.
- Initial diagnosis was frequently acute meningitis, with variable cerebrospinal fluid findings.
- CT scans were crucial for accurate diagnosis and localization.
- Two patients recovered fully with aggressive antibiotic therapy and surgical management; one patient died.
Conclusions:
- Infratentorial subdural empyema can be an unrecognized complication of acute meningitis.
- Early diagnosis via CT imaging is essential for effective management.
- Aggressive antibiotic therapy combined with surgical drainage offers the best chance for patient recovery.