Subdural empyema − case report of a rare disease with a high mortality

Abstract

Subdural empyema is a rare purulent intracranial infection. Outcome is dependent on the preoperative level of consciousness, therefore an early diagnosis and urgent neurosurgical intervention are necessary. Mortality of subdural empyema remains high, ranging from 6% to 15%.
The case report presents a patient with subdural empyema which resulted from sinusitis. The integral and first part of therapy was an urgent neurosurgical drainage of subdural empyema, followed by functional endoscopic sinus surgery performed by ENT surgeon. Conservative treatment consisted of systemic antibiotics and antiedematous therapy. Later the patient developed post-infectious hydrocephalus, which was solved by implantation of a ventriculo-peritoneal shunt. Consequently, cranioplasty was performed. Despite acute onset of the disease and severe neurologic deficit prior to the first neurosurgical intervention, the clinical condition of the patient is favorable after multiple surgeries. The patient is able to live independently without any significant limitations in everyday activities.
The presenting symptoms of subdural empyema are reflective of increased intracranial pressure, meningeal irritation, and cerebritis. Radiographic imaging (contrast CT, DWI-MRI, contrast MRI) is an essential diagnostic tool. The integral part of therapy is a neurosurgical evacuation of subdural empyema combined with intravenous antibiotic therapy.
Subdural empyema is a rare, rapidly progressing disease which is underestimated by the physicians in many cases. Diagnosis is often delayed and therefore, despite recent progress in treatment, the mortality rate remains high.