Delayed Occurrence of Escherichia coli Subdural Empyema Following Head Injury in an Elderly Patient: A Case Report and Literature Review

Abstract

Subdural empyema is a rare but serious intracranial infection that warrants prompt management to reduce morbidity and avoid mortality. However, clinical and radiologic features may be subtle or ambivalent. Thus a diagnosis of subdural empyema should not be discounted, especially in a patient with a history of head trauma. Treatment consists of surgery to establish bacteriologic identification and subsequently guide antibiotic therapy. Here we present a case of delayed Escherichia coli subdural empyema following a head injury in an elderly patient without significant risk factors. Computed tomography imaging was equivocal for subdural empyema. The patient underwent surgery and was treated with intravenous antibiotic therapy. Although initial improvement in the patient's clinical condition was observed, he eventually succumbed to nosocomial pneumonia. In this article, we discuss the presentation, diagnostic tools, and treatment options for subdural empyema with an emphasis on the challenges. The management conundrum that follows prompted us subsequently to review the literature.

Keywords

subdural empyema - head injury - antibiotic therapy - chronic subdural hematoma

• References

• 1 Le Beau J, Creissard P, Harispe L, Redondo A. Surgical treatment of brain abscess and subdural empyema. J Neurosurg 1973; 38 (2) 198-203
• 2 Post EM, Modesti LM. “Subacute” postoperative subdural empyema. J Neurosurg 1981; 55 (5) 761-765
• 3 Van Alphen HA, Dreissen JJ. Brain abscess and subdural empyema. Factors influencing mortality and results of various surgical techniques. J Neurol Neurosurg Psychiatry 1976; 39 (5) 481-490
• 4 Bakker S, Kluytmans J, den Hollander JC, Lie ST. Subdural empyema caused by Escherichia coli: hematogenous dissemination to a preexisting chronic subdural hematoma. Clin Infect Dis 1995; 21 (2) 458-459
• 5 Miedema CJ, Kimpen JL. Hematogenous dissemination of Escherichia coli to a preexistent subdural hematoma in a child. Clin Infect Dis 1996; 23 (3) 662
• 6 Vetrovec GW, Warner JF. Infected subdural hematoma: three case reports involving gram-negative organisms. Am J Med Sci 1975; 269 (1) 113-115
• 7 Greenlee JE. Subdural empyema. Curr Treat Options Neurol 2003; 5 (1) 13-22
• 8 Yilmaz N, Kiymaz N, Yilmaz C , et al. Surgical treatment outcome of subdural empyema: a clinical study. Pediatr Neurosurg 2006; 42 (5) 293-298
• 9 Dill SR, Cobbs CG, McDonald CK. Subdural empyema: analysis of 32 cases and review. Clin Infect Dis 1995; 20 (2) 372-386
• 10 Bachmeyer C, Logak M, Ammouri W, Blanc A-S. Spontaneous Escherichia coli meningitis with subdural empyema in an adult. South Med J 2005; 98 (12) 1225-1226
• 11 Tokoro K, Yamataki A, Nakajima F. Subdural empyema occurring 20 years after trauma: case report. Neurosurgery 1987; 21 (5) 724-726
• 12 Casson IR, Patel P, Blair D, Bergtraum M. Subdural empyema; caused by infection of preexisting subdural hematoma. N Y State J Med 1981; 81 (3) 389-391
• 13 Bok AP, Peter JC. Subdural empyema: burr holes or craniotomy? A retrospective computerized tomography-era analysis of treatment in 90 cases. J Neurosurg 1993; 78 (4) 574-578
• 14 Miller ES, Dias PS, Uttley D. Management of subdural empyema: a series of 24 cases. J Neurol Neurosurg Psychiatry 1987; 50 (11) 1415-1418
• 15 Wu T-J, Chiu N-C, Huang F-Y. Subdural empyema in children—20-year experience in a medical center. J Microbiol Immunol Infect 2008; 41 (1) 62-67
• 16 Mauser HW, Van Houwelingen HC, Tulleken CA. Factors affecting the outcome in subdural empyema. J Neurol Neurosurg Psychiatry 1987; 50 (9) 1136-1141
• 17 Nathoo N, Nadvi SS, van Dellen JR, Gouws E. Intracranial subdural empyemas in the era of computed tomography: a review of 699 cases. Neurosurgery 1999; 44 (3) 529-535 ; discussion 535–536
• 18 Tewari MK, Sharma RR, Shiv VK, Lad SD. Spectrum of intracranial subdural empyemas in a series of 45 patients: current surgical options and outcome. Neurol India 2004; 52 (3) 346-349
• 19 Laupland KB, Gregson DB, Church DL, Ross T, Pitout JDD. Incidence, risk factors and outcomes of Escherichia coli bloodstream infections in a large Canadian region. Clin Microbiol Infect 2008; 14 (11) 1041-1047
• 20 Rich PM, Deasy NP, Jarosz JM. Intracranial dural empyema. Br J Radiol 2000; 73 (876) 1329-1336
• 21 Iimura Y, Tsutsumi S, Mitome Y , et al. Infantile chronic subdural hematoma infected by Escherichia coli—case report. Neurol Med Chir (Tokyo) 2010; 50 (6) 482-484
• 22 Moseley IF, Kendall BE. Radiology of intracranial empyemas, with special reference to computed tomography. Neuroradiology 1984; 26 (5) 333-345
• 23 Smirniotopoulos JG, Murphy FM, Rushing EJ, Rees JH, Schroeder JW. Patterns of contrast enhancement in the brain and meninges. Radiographics 2007; 27 (2) 525-551
• 24 Chen CY, Huang CC, Chang YC, Chow NH, Chio CC, Zimmerman RA. Subdural empyema in 10 infants: US characteristics and clinical correlates. Radiology 1998; 207 (3) 609-617
• 25 Leys D, Destee A, Petit H, Warot P. Management of subdural intracranial empyemas should not always require surgery. J Neurol Neurosurg Psychiatry 1986; 49 (6) 635-639
• 26 Mauser HW, Ravijst RA, Elderson A, van Gijn J, Tulleken CA. Nonsurgical treatment of subdural empyema. Case report. J Neurosurg 1985; 63 (1) 128-130
• 27 Pathak A, Sharma BS, Mathuriya SN, Khosla VK, Khandelwal N, Kak VK. Controversies in the management of subdural empyema. A study of 41 cases with review of literature. Acta Neurochir (Wien) 1990; 102 (1–2) 25-32
• 28 Shearman CP, Lees PD, Taylor JC. Subdural empyema: a rational management plan. The case against craniotomy. Br J Neurosurg 1987; 1 (2) 179-183
• 29 Feuerman T, Wackym PA, Gade GF, Dubrow T. Craniotomy improves outcome in subdural empyema. Surg Neurol 1989; 32 (2) 105-110
• 30 Ong YK, Goh KYC, Chan C. Bifrontal decompressive craniectomy for acute subdural empyema. Childs Nerv Syst 2002; 18 (6-7) 340-343 ; discussion 344