Abstract:
OBJECTIVE:To evaluate the occurrence, treatment, and outcome of subdural empyema complicating community-acquired bacterial meningitis in adults. METHODS:Case series from a prospective nationwide cohort study from Dutch hospitals from 2006 to 2011. RESULTS:Subdural empyema was diagnosed in 28 of 1,034 episodes (2.7%), and was present on admission in 10 episodes and diagnosed during admission in 18. Predisposing conditions were present in 26 patients (93%), and consisted of otitis or sinusitis in 21 patients (75%). In all these patients the otitis or sinusitis spread to the subdural space. Twenty-three patients (82%) presented with neurologic symptoms (paresis, focal seizures, dysesthesia contralateral to the empyema). Streptococcus pneumoniae was identified in 26 patients (93%) and Streptococcus pyogenes in 1 (3%); 1 patient had negative CSF cultures. Clinical course was frequently complicated with seizures (50%), focal neurologic abnormalities (54%), and hearing impairment (39%), causing an unfavorable outcome in 19 episodes (68%). Neurosurgical evacuation of the empyema was performed in 5 patients, all with considerable midline shift. CONCLUSIONS:Although rare, subdural empyema must be considered in patients with community-acquired bacterial meningitis and otitis or sinusitis, focal neurologic deficits, or epileptic seizures. S pneumoniae is the predominant causative organism and neurosurgical intervention should be regarded as first-choice therapy in patients with empyema causing midline shift and focal neurologic abnormalities or a decreased level of consciousness.
journal_name
Neurologyjournal_title
Neurologyauthors
Jim KK,Brouwer MC,van der Ende A,van de Beek Ddoi
10.1212/WNL.0b013e3182752d0esubject
Has Abstractpub_date
2012-11-20 00:00:00pages
2133-9issue
21eissn
0028-3878issn
1526-632Xpii
WNL.0b013e3182752d0ejournal_volume
79pub_type
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