Subdural empyema natural history, complications and prognosis

If left untreated, patients with subdural empyema may develop severe fever, headache, nausea, vomiting, and seizures. Untreated subdural empyema may also lead to coma and subsequent mortality. Complications of subdural empyema include status epilepticus, neurological deficits, and thrombosis. Prognosis is generally good with antimicrobial therapy.

Subdural empyema is considered a neurosurgical emergency. If left untreated, subdural empyema frequently evolves into severe fever, headache, nausea, vomiting, seizures, coma, and subsequent mortality.

Complications to subdural empyema include:^[1]

• Status epilepticus
• Neurological deficits
• Thrombosis
• Cerebritis
• Cerebral edema
• Cerebral infarction
• Hydrocephalus
• Osteomyelitis
• Damage to the bridging veins

Prognosis is generally good with antimicrobial thearpy. The outcome is dependent on:^[1]

• Preoperative level of consciousness
• Commencement of treatment
• Treatment duration
• Disease progression

Patient education is imperative as failure to follow antibiotic therapy will adversely affect the outcome of the treatment. Identified prognostic factors associated with subdural empyema include:^[1]

Unfavorable Prognostic Factors

• Presentation with encephalopathy or coma
• Age: younger than 10 years or elderly
• Delayed commencement of antibiotics
• Burr hole placement
• Sterile cultures

Favorable Prognostic Factors

• Craniotomy
• Early treatment
• Young age (optimal between 10-20 years)
• Patient presents awake, alert and oriented
• Source of infection: paranasal sinuses
• Aerobic Streptococci isolated in culture
• Aerobic Streptococci as single pathogen

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