Infantile subdural empyema: The role of brain sonography and percutaneous subdural tapping in a resource-challenged region
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Published on: March 26, 2019
Okezie Obasi Kanu1, Chinenye Nnoli2, Omodele Olowoyeye3
1Department of Surgery, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
Insights
Trans-fontanelle ultrasound is an effective diagnostic tool for infantile subdural empyema in developing countries. Percutaneous subdural tapping offers an affordable treatment option for these patients.
Area of Science:
- Pediatric Neurology
- Diagnostic Imaging
- Infectious Diseases
Background:
- Subdural empyema is a serious childhood intracranial pathology.
- Access to advanced imaging like CT scans and MRI is limited in developing countries.
- Trans-fontanelle ultrasound scan (TFUSS) presents a more accessible and affordable alternative.
Purpose of the Study:
- To evaluate the efficacy of TFUSS in diagnosing infantile subdural empyema.
- To assess the outcomes of children treated with TFUSS and subdural tapping in resource-limited settings.
Main Methods:
- A study of seventeen infants diagnosed with post-meningitic subdural empyema using TFUSS alone.
- Treatment involved percutaneous subdural tapping over a 31-month period.
- Patient outcomes were assessed based on clinical presentation and follow-up.
Main Results:
- Ninety-four percent of patients achieved a good outcome following treatment.
- Commonly isolated organisms included Streptococcus faecalis, Haemophilus Influenza, and Staphylococcus aureus.
- Complications observed included hydrocephalus, recurrence, hemiparesis, and speech difficulties in a minority of patients.
Conclusions:
- Transfontanelle ultrasonography is adequate for diagnosing infantile subdural empyema in resource-challenged areas.
- Percutaneous subdural tap is an affordable and effective therapeutic approach for patients facing financial constraints.
- TFUSS offers a viable alternative to CT and MRI for intracranial lesion investigation in developing nations.
Background:
This study explored the outcome of children with patent anterior fontanelles who were treated with trans-fontanelle ultrasound scan (TFUSS), which is more affordable and available than CT scan and MRI in the diagnosis of childhood intracranial pathologies and treatment of subdural empyema, in developing countries.
Patients And Methods:
Seventeen infants with post-meningitic subdural empyema, diagnosed using trans-fontanelle ultrasound alone and treated with subdural tapping over a 31-months period, were studied.
Results:
Eleven patients presented with grades II and III Bannister and William grading for level of consciousness in intracranial subdural empyema. Aspirate from 7 (41.2%) patients were sterile. The most common organisms isolated were Streptococcus faecalis 3 (17.6%), Haemophilus Influenza 2 (11.8) and Staphylococcus aureus 2 (11.8), multiple organisms were isolated in three of the patients. Ninety-four percent (94%) of the patients had good outcome. Five subjects developed hydrocephalus, one patient had a recurrence of subdural empyema, four patients had residual hemiparesis, two of the four patients had speech difficulties, while one patient (~6%) died.
Conclusion:
While CT and MRI remain the gold standard for investigating intracranial lesions, transfontanelle ultrasonography is adequate for diagnosis of infantile subdural empyema in resource-challenged areas. Percutaneous subdural tap is an affordable and effective therapy in such patients with financial challenges.
