Subdural empyema occurs far less frequently than intracerebral abscess formation. Infection usually spreads from infected sinuses or mastoids, but may arise from any of the aforementioned sources. The responsible organism is usually Strep, pneumoniae, Strep, milleri or Staph, aureus. Clinical features match those of intracerebral abscess but since rapid extension occurs across the subdural space, overwhelming symptoms often develop suddenly. Seizures occur in 70% at onset.
CT scan shows a low density extracerebral collection with mass effect, often with enhancement on the cortical surface; occasionally isodense lesions make identification difficult.
Management: Intravenous antibiotic treatment is combined with evacuation of pus either through multiple burr holes or a craniotomy flap. Despite active treatment, the mortality rate still runs at approximately 20%.
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