A Review of Subdural Empyema and Its Management

Subdural empyema is a collection of purulent material between the dura mater and the arachnoid mater. It is a life-threatening complication of paranasal sinusitis, otitis media, or mastoiditis. The classic clinical syndrome is characterized by acute febrile illness that is punctuated by rapid progressive neurological deterioration, and, if left untreated, it will eventually lead to coma with fatal outcome. High-resolution contrast-enhanced computed tomographic scanning has revolutionized the diagnosis of subdural empyema; however, gadolinium-enhanced magnetic resonance imaging provides greater clarity of morphological detail. Treatment of patients with subdural empyema consists of immediate surgical evacuation only in rare circumstances where there are contraindications to surgery or significant mortality risks avoided; conservative treatment is advised. The antibiotics should be given for a period of 3 to 6 weeks with close monitoring of clinical status. Aggressive management of subdural empyema has reduced the mortality rate; still, it is associated with the high incidence of morbidity (ie, neurological deficits) because very ill patients who would have died in the past now survive with deficits. We discuss the etiopathology and diagnosis of subdural empyema and its management.