Subdural Empyema Caused by Hematogenous Dissemination from an Abscess in Thigh to a Preexisting Chronic Subdural Hematoma “Case Report”

Kawamoto, Shunsuke; Nagata, Kazuya; Mochizuki, Yubuhito; Hara, Takayuki; Abe, Tadashi; Sashida, Jun

doi:10.2176/nmc.38.743

Cited by 15 publications

(6 citation statements)

References 19 publications

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“…The incidence of infected subdural hematoma is quite low, and only 27 cases have been reported in the literature (table 1 ) [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. Although subdural empyema occurs mainly due to the spread of infectious focus near the cranium, infected subdural hematoma most likely occurs through a hematogenous infection to a preceding chronic subdural hematoma [ 14 , 18 ]. Previous reports strongly suggest that old patients [ 13 ] and compromised patients with an underlying disease such as diabetes, myelodysplastic syndrome [ 13 , 18 ] and agranulocytosis [ 14 ] are susceptible to emerge an infected subdural hematoma.…”

Section: Discussionmentioning

confidence: 99%

“…Although subdural empyema occurs mainly due to the spread of infectious focus near the cranium, infected subdural hematoma most likely occurs through a hematogenous infection to a preceding chronic subdural hematoma [ 14 , 18 ]. Previous reports strongly suggest that old patients [ 13 ] and compromised patients with an underlying disease such as diabetes, myelodysplastic syndrome [ 13 , 18 ] and agranulocytosis [ 14 ] are susceptible to emerge an infected subdural hematoma. An infected subdural hematoma is reported to cause confusion or seizure as well as signs of infection such as fever and the elevation of white blood cells or C-reactive protein [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…A preexisting subdural hematoma may transform to an infected subdural hematoma mainly through hematogenous infection. According to previous reports, the phlogogenic fungus of an infected subdural hematoma widely varies, including Escherichia coli , Klebsiella , Salmonella and Methicillin-resistant Staphylococcus aureus (MRSA) [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. In this report, we present an adult case that developed chronic subdural hematoma infected by Propionibacterium acnes .…”

Section: Introductionmentioning

confidence: 99%

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Chronic Subdural Hematoma Infected by Propionibacterium Acnes: A Case Report

et al. 2015

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We present a very rare case of a patient with an infected subdural hematoma due to Propionibacterium acnes. A 63-year-old male complained of dizziness and was admitted to our hospital. He had a history of left chronic subdural hematoma due to a traffic accident, which had been conservatively treated. Physical, neurological and laboratory examinations revealed no definite abnormality. Plain CT scan demonstrated a hypodense crescentic fluid collection over the surface of the left cerebral hemisphere. The patient was diagnosed with chronic subdural hematoma and underwent burr hole surgery three times and selective embolization of the middle meningeal artery, but the lesion easily recurred. Repeated culture examinations of white sedimentation detected P. acnes. Therefore, he underwent craniotomy surgery followed by intravenous administration of antibiotics. The infected subdural hematoma was covered with a thick, yellowish outer membrane, and the large volume of pus and hematoma was removed. However, the lesion recurred again and a low-density area developed in the left frontal lobe. Craniotomy surgery was performed a second time, and two Penrose drainages were put in both the epidural and subdural spaces. Subsequently, the lesions completely resolved and he was discharged without any neurological deficits. Infected subdural hematoma may be refractory to burr hole surgery or craniotomy alone, in which case aggressive treatment with craniotomy and continuous drainage should be indicated before the brain parenchyma suffers irreversible damage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Chronic Subdural Hematoma Infected by Propionibacterium Acnes: A Case Report

et al. 2015

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“…Very rarely seen pathogens are Escherichia coli, Pseudomonas aeuroginosa, Enterococcus faecalis and Klebsiella pneumoniae which often appeared as single case or small series in the medical literature. However, in a significant number of patients (20-30%), causative agent for SDE may not be isolated at all 3,4,6,7,9,10,13,15,19,21) . From a small number of SDE cases diagnosed to have Klebsiella species as the causative agent, two facts emerged.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Chronic Subdural Hematoma Contaminated with Klebsiella Pneumoniae : An Unusual Case

Bakar¹,

Sungur

Tekkök

2009

J Korean Neurosurg Soc

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J Korean Neurosurg Soc 45 : [397][398][399][400] 2009 This article presents the case of a bilateral chronic subdural hematoma which was contaminated with Klebsiella pneumoniae and resulted in a life-threatening central nervous system infection. After repeated of bilateral burr-hole drainage, the patient became hyperpyrexic and drowsy. Suppuration within the subdural space was suspected and then the patient underwent bilateral fronto-temporo-parietal craniotomies, and pus was evacuated. Its cultures revealed Klebsiella pneumoniae. Intravenous meropenem was given for 6 weeks. He recovered completely. Microorganisms like Klebsiella pneumoniae may directly infect the subdural space with iatrogenic contamination.

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“…Subdural empyema may also occur as a complication of neurosurgical procedures or, occasionally, after head trauma; in this latter setting, subdural empyema can occur months or years after the injury [4, Class III]. Rarely, subdural empyema will develop after bacteremic seeding of a pre-existing subdural hematoma, transforming the hematoma from a relatively indolent pathologic process into a rapidly progressive one [5,6,Class III].…”

Section: Intracranial Subdural Empyemamentioning

confidence: 99%

Subdural Empyema

Greenlee

2003

Curr Treat Options Neurol

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Subdural empyema represents loculated infection between the outermost layer of the meninges, the dura, and the arachnoid. The empyema may develop intracranially or in the spinal canal. Intracranial subdural empyema is most frequently a complication of sinusitis or, less frequently, otitis or neurosurgical procedures. Spinal subdural empyema is rare and may result from hematogenous infection or spread of infection from osteomyelitis. The most common organisms in intracranial subdural empyema are anaerobic and microaerophilic streptococci, in particular those of the Streptococcus milleri group (S. milleri and Streptococcus anginosus). Staphylococcus aureus is present in a minority of cases, and multiple additional organisms, including Gram-negative organisms, such as Escherichia coli, and anaerobic organisms, such as Bacteroides, may be present. Pseudomonas aeruginosa or Staphylococcus epidermidis may be present in cases related to neurosurgical procedures, and Salmonella species have been detected in patients with advanced AIDS; multiple organisms may be present simultaneously. Spinal subdural empyemas are almost invariably caused by streptococci or by S. aureus. Subdural empyema--whether it occurs in the skull or the spinal canal--may cause rapid compression of the brain or spinal cord, and represents an extreme medical and neurosurgical emergency. The diagnostic procedure of choice for intracranial and spinal subdural empyema is MRI with gadolinium enhancement. Computed tomography scan may miss intracranial subdural empyemas detectable by MRI. Conversely, occasion spinal subdural empyemas may be detected by CT myelography where MRI is negative. Treatment in virtually all cases of intracranial or spinal subdural empyema requires prompt surgical drainage and antibiotic therapy. Pus from the empyema should always be sent for anaerobic, as well as aerobic, culture. Because intracranial subdural empyemas may contain multiple organisms, provisional antibiotic therapy of intracranial subdural empyema, where the organism is unknown, should be directed against S. aureus, microaerophilic and anaerobic streptococci, and Gram-negative organisms. Antibiotics should include 1) nafcillin, oxacillin, or vancomycin; plus 2) a third generation cephalosporin; plus 3) metronidazole. Provisional antibiotic therapy of spinal subdural empyemas should be directed against S. aureus and streptococci, and should include nafcillin, oxacillin, or vancomycin. Morbidity and mortality in intracranial and spinal subdural empyema relate directly to the delay in institution of therapy. Both conditions should, thus, be treated with great urgency.

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Subdural Empyema Caused by Hematogenous Dissemination from an Abscess in Thigh to a Preexisting Chronic Subdural Hematoma “Case Report”

Abstract: A 63-year

Cited by 15 publications

References 19 publications

Chronic Subdural Hematoma Infected by Propionibacterium Acnes: A Case Report

Chronic Subdural Hematoma Infected by Propionibacterium Acnes: A Case Report

Bilateral Chronic Subdural Hematoma Contaminated with Klebsiella Pneumoniae : An Unusual Case

Subdural Empyema

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