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Subdural empyema

Up ADEM Brain abscess Brain death Cerebral oedema Cerebral tumours CVT CVA Coma Cord compression Delirium Encephalitis Guillain Barre syndrome ICU acquired weakness ICH Meningitis Myasthenia gravis Periodic paralysis Nerve lesions SAH Status epilepticus Subdural empyema SjO2 Tick paralysis Transverse myelitis Weakness


May be mistaken for meningitis

Aetiology

  • Subdural space infected from nasal sinuses or as a result of neurosurgical drainage
  • Usually polymicrobial infection with streptococci, staphylococci and gram negatives

Clinical features

Signs of ­ ICP are common

Investigations

CT shows collection of fluid around dura

Treatment

  • Urgent surgical drainage and antibiotics:
    - penicillin + chloramphenicol ± gentamicin OR
    - 3rd generation cephalosporin
  • Use meningitis doses but continue therapy for 3-6 weeks
  • Good supportive care is important

Prognosis

  • Neurological sequelae common
  • Mortality 10-20%

Further reading

Lipman J. Meningitis and encephalomyelitis. In Oh TE (ed), Intensive Care Manual, 4th Ed., Butterworth Heinemann, Oxford, 1997, pp 416-22

 


© Charles Gomersall December 1999

 

©Charles Gomersall, February, 2015 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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