Subdural empyema in infant meningitis: diagnosis, therapy, and prognosis

Abstract

Collections of subdural fluid during the course of infant Hemophilus influenzae meningitis have been demonstrated in the past by routine subdural taps and, more recently, by computed tomography. While the fluid is usually a benign effusion, the clinical picture and CT pattern may suggest a subdural abscess (empyema) necessitating further subdural punctures. This is a review of nine infants with subdural empyema. As reported in the literature, a remarkably good prognosis is apparent following treatment with subdural taps and systemic antibiotics. Six of seven H. influenzae cases were ampicillin-resistant in this series.

The treatment and outcome of postmeningitic subdural empyema in infants

“…Bur hole drainage and craniotomy have been used for the drainage of SDE. 6,13 In literature reviews, intermittent transfontanel needle aspiration of the SDE may provide a means of removal of pus, 5,13 but it must be performed with great caution. Some pediatric series emphasized the importance of craniotomy in achieving a better outcome.…”

Infantile subdural empyema: The role of brain sonography and percutaneous subdural tapping in a resource-challenged region

“…Curless[3] recorded negative culture stains in some of his patients who had H. Influenza meningitis. Eighteen of 37 cultures performed by Mauser and Tulleken[12] were sterile.…”

“…Curless[3] on the other hand reported that repeated subdural taps produced satisfactory results in eight of nine patients in his series. Diagnoses in these patients were done using CT scan in some and subdural taps in others.…”

“…Anticonvulsant therapy was however continued for a period of 2 years in those who had seizures though they were seizure free at 1 year. Two out of 9 patients reviewed by Curless[3] had recurrence of subdural empyema. One of his patients had severe psychomotor retardation and another patient had sustained speech problems 2 years after infection.…”

“…Subdural tap was used both for diagnosis[12345] and treatment[356] of this condition but has been largely abandoned since the advent of modern imaging techniques. Computerized tomographic (CT) scans and magnetic resonant imaging (MRI) are better diagnostic tools for intracranial conditions and have become available in many centers across the world including ours.…”