An empyema is an abscess, which is the accumulation of pus in an anatomical cavity. A subdural empyema is a subtype of empyema, and forms in the subdural area outside the brain.
Subdural space can form as a result of a separation of the membranes that connect the brain and spinal cord. Such separation usually occurs after trauma or if there is not enough cerebrospinal fluid in the patient’s brain. Membrane separation can also be a pathological process.
95% of subdural empyema cases develop in the cranium and sometimes in the frontal lobe or spinal neuraxis. According to American website Medscape, subdural empyema accounts for 15-22% of all intracranial infections. Before the introduction of penicillin, this disease was terminal. These days, survival rates are a lot better. In developed countries, the mortality rate reaches 6-35% depending on the time of diagnosis and when the treatment began.
Subdural empyema is most often caused by infectious diseases such as meningitis, otitis and mastoiditis. Infection usually spreads throughout the whole subdural space. If not treated, it can also affect the middle ear and sphenoid sinus.
For reasons as yet unclear, 80% of subdural empyema cases occur in males, predominantly in children and middle-aged men.
In most cases, patients are recommended to undergo the surgical removal of the subdural empyema once it has been found. Before the surgery, a patient needs to submit a liver function test and get prepared. The following are surgical procedures to treat subdural empyema:
If there are contraindications to surgery, the patient may be prescribed only antibiotics.
Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed
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