Subdural empyema

Subdural empyema

    * Introduction
    * Clinical
    * Diagnostic Laboratory
    * Treatment
Empyema (or your MPM) is an accumulation of pus in a cavity in the body naturally. Subdural empyema is a collection of pus in the space between the dura and arachnoid. Most empiemelor brain (95%) are located in the brain, especially in the frontal lobe. Empiemelor remaining 5% are located in the spinal cord. Subdural empyema is a neurosurgical emergency high and treatment is to remove the collection tank through the drainage holes trepan followed by subdural space, all these maneuvers adding antibiotics. Before the discovery of antibiotics, this disease is accompanied by increased mortality, passing away nearly all affected patients. Currently between 10-20% lower mortality. Empiemele are often a complication of infection from the otolaryngology and meet more often in men aged 20-40 years. Like frequency, cerebral empyema represents approximately 15-22% of all intracranial infections, predisposing factor has sinusitis.
Etiology
The most frequent pathogens responsible for the appearance of subdural empyema are aerobic and anaerobic streptococci which are found in more than half of patients. Empiemelor rest are given by staphylococci, Gram-negative aerobic and anaerobic. On admission, empirical antibiotic when entering emergency organism responsible may be suspected based on anatomical localiarea neighborhood infectious outbreak. Streptococci are responsible for the development of an outbreak due to infectious empiemelor otorinogen. Empiemele occurring after cranio-cerebral trauma or neurosurgical interventions are most commonly caused by staphylococci and Gram-negative aerobes. In rare cases, meningitis may be complicated by a subdural empyema, the etiologic agent in this situation as Streptococcus pneumoniae or Haemophilus influenzae. Other etiologic agents that are involved in this rare disease are some strains of Salmonella, Neisseria meningitidis, Campylobacter fetus and Actinomices Pasteurella strains.
Risk factors in the development of subdural empyema empyema develops most frequently on behalf of paranasal sinusitis or otitis media or from a chronic otomastoiditei. Of course that does not appear at all empyema patients with these diseases, but may occur as a complication in the case of an imunotarat or congenital defects communicating with the subarachnoid space or cavities following surgical procedures. Rhinosinusitis contain alpha-hemolytic staphylococci, golden staph, anaerobic streptococci and some strains of Enterobacteriaceae. Otitis media and mastoiditis are caused by Pseudomonas aeruginosa, Staphylococcus aureus, alpha-hemolytic streptococci and strains of Bacteroides. Other risk factors of empyema are cranio-cerebral trauma, neurosurgical, and less chronic lung infections and meningitis. Trauma and postsurgical infections contaminate the subarachnoid space with golden staph, Staphylococcus epidermidis, Enterobacteriaceae. Outbreaks of pulmonary infection can spread germs that marrow by Streptococcus pneumoniae, and Klebsiella pneumonia. In meningitis, the most frequent etiologic agents responsible for the subdural empyema is Streptococcus pneumoniae, Haemophilus influenzae, Escherichia coli, Neisseria meningitidis.
Pathophysiology
Subdural space is a virtual space, located between the arachnoid and duramater, and is divided into several compartments of the foramen magnum, the tent of the cerebellum, the brain and brain scythe. The most often from a focal infection (neighboring or remote) disseminates the subdural space through emissary veins that do not have valves. Another method is contamination of the subdural space by extending an osteomyelitis of the skull (usually in case of mastoiditis). Most supratentorial empyema develop. Paranasal sinusitis is by far an important risk factor in subdural empyema. Paranasal sinusitis (or maxillary) sinuses affects the frontal and ethmoid and sphenoidal sinus, due to proximity, and this amplifies the potential occurrence of a subdural empyema. Sphenoidal and frontal sinuses are separated only by dura mater a very thin blade bone and a sinus infection can quickly osteolysis this fragile barrier. Mastoiditis, or middle ear infections cause subdural empyema in approximately 10-20% of patients, especially if not treated. Mastoid interior has a porous structure, a structure consisting of some very fine bone blades. In case of infection (mastoiditis) viscosity is used these blades are fast and will be affected and the wall that separates the mastoid bone of duramater. You can create such a direct communication with the interior of the skull, growing into abscesses or empyema. If the factor causing otitis, empyema is initially localized around the tent of the cerebellum.
Very rarely bacterial meningitis and empyema may follow an initial subdural poured sterile. The cause of empyema is found more in children. Other predisposing factors are cranio-cerebral trauma, neurosurgical or nose, use traction devices skull and a subdural hematoma existing infection. Empiemele with distant sources of infection are also quite rare, chronic intrathoracic infection is often involved.
Once empyema take shape, it starts to spread over surfaces scythe brain convexity. It usually develops unilaterally. The expansion may cause intracranial hypertension and intracerebral penetrating. As the accompanying pathological manifestations can develop cerebral edema and cortical vein septic thrombophlebitis or dural venous sinuses can lead to a subdural hemorrhage, cerebral infarction, cerebral edema or herniation transtentoriala one.