Subdural empyema: analysis of 17 recent cases and review of the literature.

摘要: Subdural empyema is an intracranial infection that has remained difficult to diagnose and treat. Seventeen patients with this infection, treated between 1967 1974, are analyzed compared published series particular regard diagnosis using newer procedures treatment, considering the primary focus of infection. The usually located in supratentorial spaces, often bilateral, results most from para-nasal sinusitis (single common cause), otitis, neurosurgical operative infections, meningitis infants. Patients suffering subdural generally present rapid onset depressed sensorium, seizures, focal neurological deficits, signs increased pressure, following a period days weeks characterized by headache fever. All 17 our demonstrated localizing 16 manifested either fever or leukocytosis. Diagnostic studies, except for cerebral arteriography, do not reliably corroborate exclude diagnosis. Cerebral arteriography established defined location extent all cases. EEG brain scan produced frequent false-negative and/or non-localizing 10 8 patients, respectively. cerebrospinal fluid was abnormal 15 examined lumbar puncture, but findings were similar those other infectious non-infectious central nervous system diseases. Signs transtentorial herniation developed within eight hours puncture three seven who had exhibited pressure before procedure performed. Bacterial cultures positive 13 A review data studies indicates organisms associated consistent expected infections site; e.g. sinusitis, meningitis, site prior neurosurgery. therapeutic approach suggested which emphasizes specific antibiotic regimens appropriate prompt intervention evacuation spaces bilaterally. In general, combination antimicrobial therapy employing high parenteral doses penicillin G, semi-synthetic penicillinase-resistant chloramphenicol recommended.