Subdural Empyema in Children

Subdural empyema (SDE) is generally a disease of children and adolescents. The lack of specific findings in a child with SDE may lead to a rapidly fatal outcome as the result of a delay in diagnosis and treatment. The advent of newer imaging modalities, such as magnetic resonance imaging (MRI), and antibiotics has resulted in improved outcomes. This article reviews the current strategies for diagnosis and treatment of this condition. Current articles on SDE were reviewed and summarized. An overview is presented, followed by an emphasis on causation, pathogenesis, patient presentation, differential diagnosis, and treatment. The approach currently used at this institution for the management of pediatric patients with SDE is also described. Sinus and ear infections, trauma, intracranial surgery, and dental caries account for most cases of SDE. The clinician must be highly suspicious of SDE in the febrile child with neurologic signs and a recent history of ear or paranasal sinus infections. Aerobic and anaerobic streptococci are the most frequent causative organisms cultured from this infection. No definitive guidelines exist regarding duration of treatment, but most series report 2 to 6 weeks of intravenous antibiotics. Arguments have persisted over the use of burr hole drainage versus craniotomy for evacuation of subdural pus. The type of surgical procedure has little impact on the outcome, provided that it is performed early and allows for complete evacuation of the pus. The preoperative neurologic status, age of the patient, and time from presentation to treatment are the most significant determinants of outcome. Early diagnosis, early evacuation, and early use of antibiotics are the fundamental principles of SDE management.