Subdural empyema and epidural abscess in children

Area of Science:

• Pediatric Neurosurgery
• Infectious Diseases

Background:

• Intracranial infections in children, including subdural empyema and epidural abscess, require prompt diagnosis and management.
• Understanding the epidemiology and clinical presentation is crucial for effective treatment strategies.

Observation:

• A retrospective review of 31 pediatric patients treated between 1954-1981 for subdural empyema or epidural abscess.
• Subdural empyema cases were more common in infants and adolescents, often originating from paranasal sinus or ear infections.
• Epidural abscesses primarily affected older children and also stemmed from sinonasal and otic infections.

Findings:

• Streptococci were the most common pathogens identified in both conditions.
• Subdural empyema presented with focal seizures and neurological deficits, particularly in older children, carrying a 13% mortality rate.
• Epidural abscesses rarely caused focal deficits, were often diagnosed late, and had no associated mortality in this cohort.

Implications:

• Surgical management principles for pediatric intracranial infections need careful consideration of the specific diagnosis (empyema vs. abscess).
• Early recognition and intervention are vital, especially for subdural empyema, to improve outcomes.
• Further research into optimal treatment protocols for these serious pediatric infections is warranted.