Brain empyema or subdural empyema


Brain empyema or subdural empyema is a collection of pus in the subdural ​​space, the area between the brain and the dura mater. It is an extension of a pre-existing inflammation in adjacent areas, such as the sinuses. In most cases, it occurs in the intracranial cavity (brain) but may also extend to the spinal cord.


Pus collection in any cavity or body area is characterized as abscess.


So the pus collection in the subdural ​​space could be described as such, but it is called an empyema to differentiate it from the intracerebral abscess that is located within the brain rather than around it. Also the pathophysiology and evolution of the empyema is much more noisy than that of the abscess.


When the inflammation spreads to the dural space, the pus accumulates around the brain and exerts pressure on the brain, but mainly causes originally superficial thrombophlebitis in the veins of the brain which then produces to thrombosis of the large venous sinuses of the brain to cause stroke, what is characterized as venous infarction. This is a very serious picture with severe neurological effects that can even lead to death.


Brain empyema or subdural empyema - Causes


The causes that can produce empyema are:


Meningitis in children and infants
• Open skull trauma
Post-operative complication-infection
Inflammation in the sinuses (sinusitis), middle ear otitis, mastoiditis, osteomyelitis of the skull
Spread from distant regions - lungs, heart through the blood stream
• Associated with other inflammations - tuberculosis, malaria, etc.


Brain empyema or subdural empyema - Sypmtoms


Symptoms of empyema can be:

• At first

• Fever
• Headache
• Nausea
• Malaise

• More serious

• Confusion
• Sleepiness, drowsiness, somnolence

Needing urgent intervention

• Lethargos
• Epileptic seizures
• Hemiparesis
• Hemihypoaesthesia
• Visual disturbances
• Disturbances in speech


Brain empyema or subdural empyema - Treatment


The cerebral empyema is not a common disease but its consequences are disastrous. That is why early diagnosis and, of course, urgent and surgical treatment is crucial.

It is usually necessary to perform craniotomy and drainage of the pus collection.

The prognosis as long as it is treated on time is excellent.



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