Microbial Analyses of Subdural Empyema: A Case Report and Literature Review

Subdural empyema (SDE) is an infection between the dura and arachnoid mater, presenting with symptoms such as fever, headache, altered sensorium, neurological deficits, and seizures. Due to its rapidly progressive nature, early diagnosis and treatment are crucial. This paper aims to identify common pathogens, imaging findings, and the necessity of emergent neurosurgical intervention. We present the case of a 49-year-old woman with an SDE who underwent craniotomy to evacuate pus and hematoma. Cultures confirmed Streptococcus intermedius, and the patient improved postoperatively with the complete evacuation of the SDE and resolution of midline shift seen on the CT scan. A PubMed literature review focused on consolidating data to identify common pathogens, demographic details, treatment methods and duration, and outcomes in SDE. SDE requires prompt diagnosis and treatment. Contrast-enhanced brain MRI is crucial for diagnosis, showing features distinct from subdural hematoma or hygroma. Neurosurgical intervention is urgent, including craniotomy and evacuation. Postoperative broad-spectrum antibiotic therapy is essential until specific pathogens are identified, and a multidisciplinary approach is recommended.