Intracranial dural empyema.

Abstract

Intracranial dural empyema is a neurosurgical emergency with potentially devastating complications. The prognosis is adversely affected by delay in diagnosis. Modern imaging techniques, especially contrast enhanced CT and MRI, have improved the speed and accuracy of radiological diagnosis of this condition, with an associated reduction in mortality. Despite this, there may still be a delay in diagnosis, partly owing to the subtlety of early radiological signs, especially on unenhanced CT. We present cases that illustrate some of the radiological manifestations, complications and potential pitfalls in diagnosis.

A Review of Subdural Empyema and Its Management

“…In infants, SDE is most commonly a complication of purulent meningitis. 5,6 In older children, the source of SDE is typically direct extension of sinusitis or otitis media. 1,3,5 -9 Other causes include spread of infection from distant sites (viz, lungs).…”

“…1,2,4,10 Subdural empyema have been reported after secondary infection of a subdural effusion or hematoma. 1,2,5 The infection can spread from mastoid or middle ear infections by eroding the tegmen tympani 11 and from the frontal air sinus by erosion of its posterior wall. 12 The infection can also spread by retrograde septic thrombophlebitis.…”

Subdural Empyema Complicating Sinusitis

“…It confirms the presence and delineates the extent of the intracranial complication (28). The classic appearance of SDE on a CT scan is a thin low-density collection over the cerebral convexity or in the interhemispheric fissure that has a rim of contrast enhancement (29,30). A CT scan with contrast is usually sufficiently sensitive to detect an SDE.…”

Brain Infection After Cesarean Section: A Case of Subdural Empyema Post-Cesarean Section

“…The infection is reported as 80% in men. Nearly two-thirds of patients are aged between 10 and 40 years (2,3). There are some reasons to get SDE, which is the most common complication of purulent, including the direct extension of sinusitis or otitis media, especially in older children, and spreading from distant sites.…”

“…On MRI, SDEs are hypointense on T1 weighted images and hyperintense on T2 weighted images. MRI image is more sensitive than CT scan to diagnose the complications of subdural empyema such as early stage of abscess formation and cerebral vein thrombosis (2). Accurate diagnosis and timely neurosurgery intervention combined with appropriate antibiotic therapy are the gold standard treatment.…”