Dr.M.Manoranjitha kumariMadras Institute Of Neurology

Chennai

Case • 75 years male • Admitted on 6/07/10• c/o pus discharge from prvious burr hole site

wound for 1 week• Low grade continuous fever- 1 week• Head ache – 1 week• No limb weekness, fits, LOC• Non DM TB

29/09/2002Under LA right frontal burrhole, parietal limited craniectomy and evacuation of chronic SDH done

Post op CSF leak and secondary suturing done

27/04/2002Retapping of chronic SDH

29/05/03 Granulation tissue excision from right parietal burr hole

On examination:Conscious, no neurological deficit, fundus

normalPus discharge from frontal burr hole site

Right fronto parietal craniotomy and evacuation of pus and excision of outer membrane

Pus culture – pseudomonas , sensitive to amik, cipro

Post op

Discussion Incidence 66%- prior craniectomy 29%-sinusitis, CSOM 11- years study -47 patients(retrospective

analysis)

JNS-1994 june 34Intracranial suppuration –a modern decade of post op suppurative empyema, epidural abscess– hlavin et al, university hospital cleveland, ohio

Subdural empyema from chronic SDH 1%50% in patients undergo repeated surgeryCalcification of chronic subdural empyema-

rare, till 2006 4 cases( neurosurgery quarterly sep 2006 vol 16 152-154)

• Usually unilateral• Limited by specific boundaries like falx,

tentorium, base of brain and foramen magnum

• Behaves expanding mass– increase ICP, cerebral parenchymal penetration, cerebral edema and hydrocephalus due to disruption of blood and CSf flow by elevated ICP

• Infarction- thrombosis of cortical veins• Septic venous thrombosis of contiguous veins

in subdural empyema

Anaerobic aerobic streptococciFollowing cranial surgery- staph aureusMortality- 18.5%

Thank you