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Subdural empyema--continuing diagnostic problems in the CT scan era
Abstract:
Fourteen cases of subdural empyema seen in Oxford since the introduction of the CT scanner are reviewed; 11 were male and 12 survived. The clinical presentation was stereotyped and characterised by severe headache, fever and meningism followed after a few days by rapidly progressive drowsiness, focal signs, papilloedema and seizures. All had radiological evidence of paranasal sinus disease (particularly frontal) although this was not apparent clinically in the majority. Plain skull and sinus radiographs remain important early investigations. Over-reliance can be placed on the CT scan which initially may be normal or show only non-specific hemisphere swelling. Parafalcine collections are easily missed. The diagnosis of subdural empyema remains difficult and a high index of clinical suspicion is required. Outcome depends on prompt treatment with parenteral antibiotics and surgical drainage.
Insights
Subdural empyema, a serious brain infection, often presents with severe headache and fever. Early diagnosis and prompt surgical drainage are crucial for patient survival.
Area of Science:
- Neurology
- Neurosurgery
- Infectious Diseases
Background:
- Subdural empyema is a rare but life-threatening infection.
- Prompt diagnosis and treatment are essential for favorable outcomes.
Purpose of the Study:
- To review cases of subdural empyema diagnosed after CT scanner introduction.
- To identify clinical and radiological features, and assess outcomes.
Main Methods:
- Retrospective review of 14 subdural empyema cases.
- Analysis of clinical presentation, radiological findings, and treatment outcomes.
Main Results:
- 11 males and 12 survivors in the reviewed cases.
- Stereotyped presentation: headache, fever, meningism, drowsiness, focal signs, papilledema, seizures.
- Radiological evidence of paranasal sinus disease common, though not always clinically apparent.
- CT scans can be normal or non-specific early on; parafalcine collections may be missed.
- Plain skull and sinus radiographs are important early investigations.
Conclusions:
- Subdural empyema diagnosis requires a high clinical suspicion.
- Prompt treatment with parenteral antibiotics and surgical drainage is critical for survival.
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