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The meninx is a membrane that envelopes the brain and the spinal cord . It is made up of 3 stratum namely , the dura mater , the arachnid space and the pia mater . The chief social function of the meninges is to protect the encephalon and the spinal cord enclosed within . It protect the brain and thespinal cordfrom any neurological trauma or wound . The subdural space ( also known as subdural cavity or the epiarachnoid space ) is the space that is potentially formed as the arachnoid mater divide from the dura mater . This occurs as a result of trauma or other pathologic condition such as subduralhematomaor subdural empyema . The subdural space is generally called as the potential or the artificial space .
An Overview of Subdural Empyema
Subdural empyema is a experimental condition which is characterize by assembling of purulent material in the subdural distance between the arachnid mater and the dura mater . It is a eccentric of abscess cause by intracranial focal appeal of pus like material . It has been noted that about 95 % of the cases affects within the cranium predominantly in the head-on lobe . A minor part of the cases involve spinal link . The former character or the intracranial case is assort with inflammation of the learning ability and fence in meninges , and also compaction of the mentality .
Subdural empyema is a life threatening contagion and studies have shown that about 15 - 22 % of all focal intracranial contagion is make by subdural empyema . The first case of subdural empyema was report about 100 years ago . Before the discovery of penicillin , the mortality rate of subdural empyema was very gamy .
Symptoms of Subdural Empyema
The symptoms of subdural empyema are subaltern to increased intracranial air pressure , meningitis and infection . Occurrence of intellectual infarct is quite distressing . The most commonly encountered symptom of subdural empyema include :
If subdural empyema is not treated right away , it can lead to lasting damage . It can lead to neurological ramification and even death in certain cases .
Epidemiology of Subdural Empyema
In United States , about 15 – 22 % of focal intracranial transmission are have by subdural empyema . Sinusitis , otitis mediaand mastoiditis are the most mutual predisposing factor . With growth in antibiotic , the mortality charge per unit has reduced importantly . In developed countries the mortality rate charge per unit is about 6 – 35 % with morbidness rate ( neurological deficit ) of about 55 % . The decrease in mortality rate is also because of the advancement in investigative procedures . Subdural empyema is more common among males than in female ( accounting up to 80 % of the causa ) . The exact intellect for mellow incidence in men is yet unnamed . The most accepted theory being that there is a departure in the anatomical development of the paranasal sinuses in male person and female . It can come about at any age ; however it is most unremarkably determine between the age of 10 – 40 year .
Causes and Risk Factors of Subdural Empyema
Bacterial infection is the most uncouth cause of subdural empyema followed by fungal and protozoic infection . In kid , subdural empyema can be make as a complicatedness of meningitis . Other routes through which the transmission can invade includes :
Pathophysiology of Subdural Empyema
As mentioned in the beginning , subdural empyema is make by focal infection between the arachnoid quad and the dura mater . The infection spreads rapidly until limited by complex body part such as falx cerebri , radix of the brain , foramen magnum , tentorium cerebelli etc . The infection usually spreads one-sidedly . Over a stop of time the intracranial force per unit area increases due to spread on transmission . This also head to intraparenchymal penetration , disruption of descent stream and CSF or cerebrospinal fluid flow which leads to cerebral oedema and hydrocephalus . There may be infected venous thrombosis of contiguous veins and thrombosis of the cortical veins or cavernous sinuses which may lead to cerebral infarction . In nipper , subdural empyema may be petty to meningitis .
The infection commonly enters through the head-on fistula or the ethmoid bone sinuses . It can also enter through the sphenoid sinus , mastoid cellular telephone and the middle ear . The condition is predispose by sinusitis , which is trace by spread of infection into the venous sinus through thrombophlebitis . Infection can also spread due to erosion of the posterior wall of the mastoidal or head-on sinus , or directly from an intracerebral abscess . Very rarely , the source of contagion is a remote foci from tortuousness of trauma , surgery or blood poisoning .
Complications of Subdural Empyema
Subdural empyema is characterize by sharp afebrile condition with speedy reformist neurologic reflection . If leave untreated , subdural empyema can be fateful . It can lead to coma and permanent neurological deterioration .
Diagnosis of Subdural Empyema
Diagnosis and direction of subdural empyema is done by an experient neurologist . The symptom of subdural empyema are nearly evaluated . ground on the symptoms , investigative examinations are recommend for further valuation and planning . A declaration enhanced MRI of the brain is helpful in the diagnosis of the condition . Gadolinium enhanced MRI provides good clearness . A contrast enhanced CT scan may also be considered . A comprehensive rakehell study is also obtained for valuation of the stipulation . line of descent samples and other surgical specimens are usually cultured and canvas anaerobically and aerobically . Gram spotting and sensitiveness tests are considered too . Lumbar puncture is not very helpful in this stipulation and it is often avoided . Lumbar puncture can run to transtentorial herniation . In small fry and infants , subdural hydrant is done to relieve pressing .
Treatment of Subdural Empyema
Treatment for subdural empyema involves operative drainage follow by antibiotic coverage based on the causative pathogen . Once subdural empyema is diagnosed , quick operative evacuation is counsel . The most usual surgical subprogram that is considered for management of the symptoms of subdural empyema is called craniotomy . It is a surgical procedure which involves adequate mentality exposure and exploration which in turn helps in well evacuation of the purulent stuff . Other surgical options include stereotactic burr hole placement . In rarefied cases with increase risk of death rate , surgical intervention may be contraindicate . Antibiotic coverage post - surgery is generally given for a period of 3 to 6 week . In some cases anticonvulsants and step to scale down intracranial pressure level is required .
Other Treatment Options For Subdural Empyema Include :
Subdural empyema is a condition make by transmission and accumulation of focal purulent fabric in the space between the dura mater and arachnoid mater . It is most usually predisposed by sinusitis , otitis medium and mastoiditis . In kid , subdural empyema may be predispose by meningitis . The symptom of subdural empyema are petty to increased intracranial pressure and let in increased temperature , nausea , vomiting , generalised impuissance , worry etc . In contrary cases , it can leave to life-threatening neurologic issues , coma and even death . Hence , seeking instantly medical help is propose to subdue the damage to lower limit .
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