Background Brain abscesses are still a very important pathology, with high mortality and morbidity, even with the advancement of imaging technologies and antibiotic treatment In this study, we analyzed the relationship between clinical, biological and therapeutic features at admission and clinical outcome in patients with brain abscesses Material and method This is a retrospective study over 52 consecutive patients with brain abscesses treated in our Neurosurgical Department during 8 years, between January 2003 and December 2011 Laboratory tests, cerebral CT or MRI scans, blood and urine cultures were performed Surgical treatment consisted of either CT guided stereotactic aspiration or craniotomy with the resection of the abscess Materials from the brain abscess were cultured for aerobic and anaerobic bacteria Parenteral antibiotic therapy usually lasted between 6 to 8 weeks Results Clinical outcome was assessed at 6 months endpoint by using Glasgow Outcome Scale (GOS) The most common cause of brain abscess was hematogenous spread There were 41 patients with solitary and 11 with multiple brain abscesses Regarding microbiological findings, we obtained positive cultures from brain materials in 41 patients Stereotactic aspiration was performed in 33 patients, surgical excision in 15 and medical therapy alone in 4 patients As clinical outcome, 846% patients had a favorable outcome (GOS 5 and 4) and 154% had an unfavorable outcome (severe disability - 4 and death - 4) Conclusions Early diagnosis, optimal surgical intervention and timely use of appropriate antibiotics are essential for a good outcome No significant difference in outcome was found among various surgical treatment modalities For mortality, initial Glasgow Coma Score (GCS) 8, associated predisposing factors and systemic infections were significant contributing factors

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Brain abscesses: clinical experience and outcome of 52 consecutive cases.

Background: Controversy regarding the best management strategy for subdural empyema (SDE) attests to the persisting poor outcomes for this uncommon life threatening intracranial suppurative process. Late presentation confounds the problem in developed countries. While craniotomy is commonly recommended, it is not always possible in late presentation with advanced morbidity. The aim of this study was to identify the pattern of clinical presentation and explore the outcomes following management of SDE using burr hole, aspiration, and drainage (BAAD) in resource poor settings. Materials and Methods: This is a retrospective review of prospectively collected data of 18 patients presenting with SDE over a period of 10 years from two neurosurgical centers. Data was abstracted on patients' demographic characteristics, sources of SDE, clinical presentation and site of infection, methods of diagnosis, organisms isolated, treatments received, and outcome. Collected data was entered into the Statistical Package for the Social Sciences version 17 software and subjected to descriptive analysis for all variables. Results: Majority of the patients presented late with Glasgow Coma Scale score GCS of 9/15. Altered sensorium was noted in 14 (77.8%) of the patients, 11 (61.1%) out of the 14 patients had ≤ grade 3 of Bannister and Williams level of consciousness. The mainstay of treatment for all patients was BAAD of abscess and administration of appropriate antibiotics. Fourteen patients (77.8%) were discharged on grade A of H.W. Mauser's grading system. Three mortalities were recorded only in patients who had grade 4 Bannister and Williams grading. Conclusion: BAAD is the near approximated option to standard craniotomy management in a limited resource facility and it has a very good clinical outcome. However, more studies are required to draw the final conclusion.

/pdf/subdural-empyema-clinical-presentations-and-management-602sfb417a.pdf

Subdural empyema: Clinical presentations and management options for an uncommon neurosurgical emergency in a developing country.

The outcome of intracranial subdural empyema at Steve Biko Academic Hospital : retrospective study

Surgical Approaches in the Treatment of Intracranial Complications of Paranasal Sinus Disease: A Review of the Literature

Malaria remains a significant public health problem of the tropical world. Falciparum malaria is most prevalent in the sub-Saharan African region, which harbors about 90% of all malaria cases and fatalities globally. Infection by the falciparum species often manifests with a spectrum of multi-organ complications (eg, cerebral malaria), some of which are life-threatening. Spontaneous subdural empyema is a very rare complication of cerebral malaria that portends a very poor prognosis unless diagnosed and treated promptly. We report a case of spontaneous subdural empyema in a 58-year-old woman from Tanzania who presented with high-grade fever, decreased urine output, and altered sensorium.

https://journals.sagepub.com/doi/pdf/10.1177/2324709616666567

Spontaneous Subdural Empyema Following a High-Parasitemia Falciparum Infection in a 58-Year-Old Female From a Malaria-Endemic Region A Case Report

Cranial subdural empyema (SDE), a localized septic intracranial collection, occurs mostly as a complication of sinusitis, otitis or mastoiditis. Although relatively rare, SDE requires an increased attention for early recognition, cerebral imagery being mandatory in any suspected case. Any delay in treatment can lead to coma with a fatal outcome. The authors report the case of a young boy, who developed a severe, important cerebral edema, thin subdural collection with minimal displacement of the median line. Repeated cerebral MRI showed an enlarged subdural collection with higher median line shift and imposed rapid surgical intervention. The collection proved to be empyema. Other findings on MRI are pansinusitis, mild mastoiditis and transverse sinus thromboflebitis. The recovery was accompanied by the need for long course of antibiotherapy, secondary epilepsy treatment and kinetotherapy for hemiparesis. The patient also developed intracerebral cysts expanding the brain through the postoperative cranial defect which later needed surgical intervention, for both neurological and esthetic improvement. The management of the case implied strong interdisciplinary collaboration between infectionist, neurologist, neurosurgeon, microbiologist and imagist.

Nica M

Papers

Multidisciplinary management and outcome in subdural empyema--a case report.