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Ochsner J. 2014 Summer;14(2):188-94.

Intracranial subdural empyema: a 10-year case series.

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Department of Neurosurgery, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Department of Plastic and Reconstructive Surgery, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
Department of Psychiatry, Prince Charles Hospital, Chermside, Queensland, Australia.
Department of Neurosurgery, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.



Intracranial subdural empyema (ISDE) is a pyogenic infection located in the space between the dura and arachnoid mater. Early diagnosis, prompt initiation of antimicrobial therapy, and surgical drainage are essential to reduce morbidity and mortality. This case series analyzes the presentation and management of ISDE in Queensland, Australia, over a 10-year period.


Thirty-six patients with ISDE were treated at Gold Coast University Hospital, Princess Alexandra Hospital, Townsville Hospital, and Royal Brisbane Hospital. The patients' medical records were analyzed to ascertain patient demographics, etiology, presentation, and management.


A slight male preponderance occurred in the cohort of 36 patients with ISDE. The most common source of infection was a neurosurgical procedure, followed by sinusitis and otogenic sources. Headache, fever, and altered sensorium were the most common clinical triad of symptoms, present in 19 (53%) patients. Craniotomy was performed as the initial surgical procedure in 28 (88%) of the 32 patients who required surgery. Seizure prophylaxis was given to 25 (69%) patients, with 8 (32%) of those patients having seizures during their hospitalizations despite this therapy. Five (14%) patients required readmission and a second craniotomy because of failed resolution of the ISDE.


Altered sensorium, fever, vomiting, and headache should alert the clinician to the possibility of ISDE. A history of neurosurgery, sinusitis, otitis media, or skull trauma increases the likelihood of this differential. Management includes sensitive antibiotic therapy and surgical drainage. Compared with burr hole, craniotomy is associated with less recurrence of ISDE.


Craniotomy; drug therapy–combination; empyema–subdural


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