Hematogenous seeding of the space is more likely to result in spinal subdural empyema. This location is less common, accounting for less than 5% of subdural empyema. Staphylococcus aureus is often implicated in infections in this location. Patients may present with fever, headache, and altered mental status (or some combination of these symptoms). Focal neurological signs and seizures may also be present. Magnetic resonance imaging (MRI) with contrast is the diagnostic test of choice.
Treatment is with a combination of surgical decompression and antibiotic therapy. Complications include cerebritis, cerebral abscess formation, and venous sinus thrombosis. Morbidity and mortality in subdural empyema is directly related to delay in therapy.
G06.2 – Extradural and subdural abscess, unspecified
37660004 – Subdural abscess
Differential Diagnosis & Pitfalls