View source for Subdural empyema

==Background==
*Usually complications of [[sinusitis]] (especially frontal, ethmoidal, or sphenoidal) or [[otitis media]]
**Other causes include other ear infections, [[head trauma|cranial trauma]] or surgery, or rarely [[bacteremia]]
**In children <5yo, cause is typically bacterial meningitis
*Typically due to epidural abscess extending into subdural space to cause subdural empyema


==Clinical Features==
*[[Fever]]
*[[Headache]]
*[[Lethargy]]
*[[Focal neuro deficits]], particularly with rapidly developing neuro deficits suggesting involvement of entire hemisphere
*[[Seizures]]
*Complications
**[[Meningitis]]
**Cortical venous thrombosis
**[[Brain abscess]] 

==Differential Diagnosis==
*[[CVA]]
*[[Meningitis]], [[encephalitis]]
*Malignancy

{{Intracranial mass DDX}}


==Evaluation==
*Assess for alternative causes of symptoms (e.g. labs to rule out metabolic process, glucose, infectious workup)
*[[brain MRI|MRI brain]] with contrast
*Blood cultures
*Definitive diagnosis by culture of surgical specimens
*[[LP]] ''NOT'' helpful and may precipitate herniation
*In infants, a subdural tap may be diagnostic and may relieve pressure

==Management==
*Address airway protection 
*Antibiotics similar to those used for brain abscess: e.g. [[cefotaxime]], [[ceftriaxone]], [[metronidazole]], [[vancomycin]]
**In children, cover also for bacterial meningitis
*Emergent neurosurgery consult for drainage


==Disposition==
*Admit

==See Also==


==External Links==


==References==
<references/>
[[Category:ID]] [[Category:Neurology]]