Section 6. Brain, Spinal Cord, and Nerve Disorders

Chapter 89. Infections of the Brain and Spinal Cord

Topics: Introduction | Acute Bacterial Meningitis | Chronic Meningitis | Viral Infections | Brain Abscess | Subdural Empyema | Parasitic Infections

Subdural Empyema

A subdural empyema is a collection of pus that develops between the brain and the layers of tissue covering it (meninges), rather than in the brain itself.

A subdural empyema may result from a sinus infection, a severe ear infection, a head injury, surgery, or a blood infection that develops after a lung infection. The same kinds of bacteria that cause brain abscesses can cause subdural empyemas.

Like a brain abscess, a subdural empyema can cause headache, sleepiness, seizures, and other signs of brain dysfunction. The symptoms can evolve over several days, and without treatment, they progress rapidly to coma and death.

Computed tomography (CT) and magnetic resonance imaging (MRI) are the best procedures for diagnosis. A spinal tap is of little help and may be dangerous. In infants, a needle can sometimes be inserted directly into the empyema through a fontanelle (a soft spot between the skull bones) to drain the pus, relieve pressure, and help doctors make the diagnosis.

Subdural empyemas must be drained surgically. If the infection occurred because of an abnormality in the sinuses, the surgeon usually repairs the abnormality at the same time. Antibiotics are given intravenously.