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Subdural empyema
Last reviewed: 04.07.2025
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Subdural empyema is a collection of pus between the dura mater and arachnoid mater of the brain. The disease is accompanied by fever, lethargy, focal neurological symptoms and seizures. Diagnosis is based on CT with contrast or MRI. Treatment consists of surgical drainage and antibiotic therapy.
[ Causes subdural empyema
In most cases, subdural empyema is a complication of infection of the paranasal sinuses (especially the frontal and ethmoid sinuses), but it can also be a consequence of otitis, craniocerebral trauma, neurosurgical interventions, or bacteremia. The causative agents are the same as in brain abscess. In children under 5 years of age, subdural empyema usually develops as a complication of bacterial meningitis, and with the decrease in the incidence of meningitis, the incidence of subdural empyema has decreased accordingly. Common complications are thrombosis of the cortical veins and brain abscess.
Symptoms subdural empyema
Over the course of several days, headache, lethargy, focal neurological symptoms and epileptic seizures, and vomiting develop against the background of fever. Meningeal signs and congestion of the optic discs are detected during examination. Without treatment, the condition rapidly worsens, coma and death occur.
Diagnostics subdural empyema
Contrast-enhanced CT or MRI can help establish the diagnosis. Blood and intraoperative samples are cultured on aerobic and anaerobic culture media. Lumbar puncture is of little information, but may provoke transtentorial herniation.
If subdural empyema is suspected (based on persistent symptoms, presence of focal neurological deficit or risk factors) in patients with meningeal signs, lumbar puncture is contraindicated until mass effect is excluded by neuroimaging methods. In infants, subdural puncture may have diagnostic and therapeutic value (reduction of intracranial pressure).
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Treatment subdural empyema
Urgent surgery to drain the empyema is indicated, as well as the associated sinus if it is the source of infection. Pending culture results, empirical antibiotic therapy (as for brain abscess) is given, except in infants, who may require antibiotics for concomitant meningitis. Subdural empyema requires anticonvulsants and measures to reduce intracranial pressure.