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NeuroSurgery Conference. Clerk June 11, 2010 2-3 PM. ASSESSMENT. Left Fronto -Parietal Subdural Empyema secondary to left frontal sinusitis. DISCUSSION. CNS INFECTIONS. Meningitis – inflammation of the meninges of the brain or spinal cord Encephalitis – inflammation of the brain

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neurosurgery conference

NeuroSurgery Conference

Clerk

June 11, 2010

2-3 PM

assessment
ASSESSMENT
  • Left Fronto-Parietal Subdural Empyema secondary to left frontal sinusitis
cns infections
CNS INFECTIONS
  • Meningitis – inflammation of the meninges of the brain or spinal cord
  • Encephalitis – inflammation of the brain
  • Myelitis – inflammation of the spinal cord
  • Neuritis – inflammation of the peripheral nerves
cns infections1
CNS INFECTIONS
  • Brain abscess – focal intracranial suppuration in the brain substances
  • Subdural empyema – infection between dura mater and subarachnoid space
  • Epidural abscess – focal suppuration between skull and dura mater
cns infections2
CNS INFECTIONS
  • Three locations where infection may occur:
    • Subarachnoid Space
    • Subdural Space
    • Epidural Space
route of infection
ROUTE OF INFECTION
  • Hematogenousspread
    • Direct foci of infection
    • Parenteral entry
  • Direct Extension
    • Sinusitis
    • Otitis
    • Mastoiditis
    • Dental Infections
  • Direct Introduction
    • Head trauma
    • Neurosurgical procedure
    • Lumbar puncture
    • Spinal anesthesia
subdural empyema
SUBDURAL EMPYEMA
  • Collection of pus between the dura and arachnoid membranes
subdural empyema1
SUBDURAL EMPYEMA
  • 15-25% of focal suppurative CNS infections
  • SINUSITIS (Frontal Sinuses) – most common predisposing condition
  • Predilection to young males 3:1, 20-30’s
  • Complication of trauma or neurosurgery
  • Secondary infection
signs and symptoms
SIGNS AND SYMPTOMS
  • Hx of Chronic sinusitis or mastoiditis
management
MANAGEMENT
  • Medical Emergency
    • 3rd gen cephalosporin, vancomycin and metronidazole
    • Minimum of 4 weeks
  • Emergent neurosurgical evacuation
    • definitive step
    • Burr-hole drainage or craniotomy
    • Gram’s stain and culture
prognosis
PROGNOSIS
  • Influenced by the ff:
    • Level of consciousness at hospitalization
    • Size
    • Time of intervention