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November 20, 2012; 79 (21) Article

Subdural empyema in bacterial meningitis

Kin K. Jim, Matthijs C. Brouwer, Arie van der Ende, Diederik van de Beek
First published November 7, 2012, DOI: https://doi.org/10.1212/WNL.0b013e3182752d0e
Kin K. Jim
From the Departments of Neurology (K.K.J., M.C.B., D.v.d.B.) and Medical Microbiology (A.v.d.E.) and The Netherlands Reference Laboratory for Bacterial Meningitis (A.v.d.E.), Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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Matthijs C. Brouwer
From the Departments of Neurology (K.K.J., M.C.B., D.v.d.B.) and Medical Microbiology (A.v.d.E.) and The Netherlands Reference Laboratory for Bacterial Meningitis (A.v.d.E.), Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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Arie van der Ende
From the Departments of Neurology (K.K.J., M.C.B., D.v.d.B.) and Medical Microbiology (A.v.d.E.) and The Netherlands Reference Laboratory for Bacterial Meningitis (A.v.d.E.), Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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Diederik van de Beek
From the Departments of Neurology (K.K.J., M.C.B., D.v.d.B.) and Medical Microbiology (A.v.d.E.) and The Netherlands Reference Laboratory for Bacterial Meningitis (A.v.d.E.), Center of Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
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Citation
Subdural empyema in bacterial meningitis
Kin K. Jim, Matthijs C. Brouwer, Arie van der Ende, Diederik van de Beek
Neurology Nov 2012, 79 (21) 2133-2139; DOI: 10.1212/WNL.0b013e3182752d0e

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ABSTRACT

Objective: To evaluate the occurrence, treatment, and outcome of subdural empyema complicating community-acquired bacterial meningitis in adults.

Methods: Case series from a prospective nationwide cohort study from Dutch hospitals from 2006 to 2011.

Results: Subdural empyema was diagnosed in 28 of 1,034 episodes (2.7%), and was present on admission in 10 episodes and diagnosed during admission in 18. Predisposing conditions were present in 26 patients (93%), and consisted of otitis or sinusitis in 21 patients (75%). In all these patients the otitis or sinusitis spread to the subdural space. Twenty-three patients (82%) presented with neurologic symptoms (paresis, focal seizures, dysesthesia contralateral to the empyema). Streptococcus pneumoniae was identified in 26 patients (93%) and Streptococcus pyogenes in 1 (3%); 1 patient had negative CSF cultures. Clinical course was frequently complicated with seizures (50%), focal neurologic abnormalities (54%), and hearing impairment (39%), causing an unfavorable outcome in 19 episodes (68%). Neurosurgical evacuation of the empyema was performed in 5 patients, all with considerable midline shift.

Conclusions: Although rare, subdural empyema must be considered in patients with community-acquired bacterial meningitis and otitis or sinusitis, focal neurologic deficits, or epileptic seizures. S pneumoniae is the predominant causative organism and neurosurgical intervention should be regarded as first-choice therapy in patients with empyema causing midline shift and focal neurologic abnormalities or a decreased level of consciousness.

Glossary

ADC=
apparent diffusion coefficient;
DWI=
diffusion-weighted imaging;
NRLBM=
Netherlands Reference Laboratory for Bacterial Meningitis

Footnotes

  • Study funding: Funding information is provided at the end of the article.

  • Go to Neurology.org for full disclosures. Disclosures deemed relevant by the authors, if any, are provided at the end of this article.

  • Received April 23, 2012.
  • Accepted July 31, 2012.
  • © 2012 American Academy of Neurology
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