Diagnosis and Treatment of Acute Subdural Empyema

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Abstract
Acute subdural empyema usually develops from pansinusitis, occasionally from infected penetrating skull wounds or from infected subdural hematoma. The pyogenic infection reaches the subdural space either by direct extension or by septic thrombo-phlebitic propagation; it may be complicated by orbital cellulitis, subperiosteal abscess, cranial osteomyelitis or intracerebral abscess. The rapid clinical course is characterized by signs of meningeal irritation, focal convulsions, hemiparesis and coma. If pus accumulates over the hemispheral convexity, motor Jacksonian attacks of face and arm preceed aphasia and hemiparesis, if the empyema is located in the interhemis-pheral fissure seizures of the leg are followed by sensory and motor paralysis of the leg and homonymous hemianopsia. The cerebrospinal fluid shows a meningitic reaction but usually remains sterile. Subdural empyema is invariably fatal unless promptly treated. Present successful management consists of immediate drainage of empyema through multiple trephine openings, intermittent irrigation of the subdural space with antibiotic solutions, and additional systemic use of massive doses of sulfonamides and antibiotics. Apparent recovery of the patient must be confirmed by pneumographic studies in order not to overlook residual chronic subdural or intracerebral abscess.

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