Intracranial suppuration: A clinical comparison of subdural empyemas and epidural abscesses. Commentary

BACKGROUND We compared the clinical features and therapeutic outcomes of intracranial suppurations (IEs) caused by subdural empyema (SDEs) and epidural abscesses (EAs). METHODS Twenty-four patients with IE were retrospectively identified at our institution over a period of 14 years. Therapeutic outcomes at 6 months were determined using the Glasgow Outcome Scale. RESULTS Among them, 15 had SDE and nine had EA with or without SDE. The three most frequently encountered clinical features included fever (79%), disturbed consciousness (58%), and seizures (54%). Postneurosurgical or posttraumatic states (42%) and complication after meningitis (38%) were the two most common modes of infection. The overall mortality rate was 8% (2/24). However, if mortality and severe neurologic sequelae were included in the poor outcome group, then 29% (7/24) of our patients would be considered treatment failures. CONCLUSION In this study, SDE commonly arose following bacterial meningitis with a more fulminant course, but no deaths occurred. In contrast, EA commonly has a more indolent course and is postoperatively or post-traumatically related, and therefore may have a higher mortality rate based on primary brain pathophysiology alone. In patients with meningitis or who undergo postneurosurgical procedures and develop fever, progressive disturbed consciousness, seizures, and focal neurologic signs, immediate neuroimaging studies should be performed to determine whether IE is present. Early surgical drainage and aggressive antimicrobial therapy are necessary.