[Acute Subdural Empyema]

Acute subdural empyema is a severe intracranial infection characterized by purulent accumulation between the dura mater and the arachnoid. It commonly affects children and young adults, typically as a complication of sinusitis, otitis media, or bacterial meningitis. In adults, however, head trauma and postoperative c infections are more common causes. Clinical symptoms include fever, headache, seizures, focal neurological deficits, and altered consciousness, with rapid neurological deterioration due to increased intracranial pressure. Diagnosis relies heavily on magnetic resonance imaging, with diffusion-weighted imaging detecting characteristic high-intensity signals. Although computed tomography may aid in initial evaluation, it is less sensitive for accurate diagnosis. Laboratory findings typically show elevated inflammatory markers, while bacterial cultures are often negative. Treatment involves prompt administration of antibiotics such as third-generation cephalosporins, vancomycin, and metronidazole, followed by adjustment based on culture results. Surgical intervention, via burr hole drainage or craniotomy, is often required for pus evacuation and decompression. Treatment of the primary infection source, such as sinus surgery, may also be necessary. Prognosis depends on the patient's condition at presentation and the speed of intervention. Although outcomes have improved with modern therapies, mortality remains substantial in severe cases, and long-term neurological sequelae are common.