neurologic disorders
Intracranial Epidural Abscess and Subdural Empyema
Key Points
Epidural abscess and subdural empyema may progress to meningitis, cortical venous thrombosis, or brain abscess; subdural empyema can rapidly spread to involve an entire cerebral hemisphere. Fever, headache, lethargy, focal neurologic deficits, and seizures usually evolve over several days; vomiting and papilledema are common. Without treatment, coma and death occur rapidly. Use contrast-enhanced MRI or, if MRI is not available, contrast-enhanced CT to diagnose epidural abscess or subdural empyema. Lumbar puncture provides little useful information and may precipitate transtentorial herniation. Drain the epidural abscess or subdural empyema and any underlying fluid in the sinuses as soon as possible, and treat with antibiotics (eg,cefotaxime,ceftriaxone,metronidazole,vancomycin). 