Paediatric intracranial empyema: differences according to age

Abstract

No recent studies are available which consider the epidemiology and outcome of paediatric intracranial empyema (PICE). We retrospectively studied all PICE cases admitted in our institution from 1993 to 2006. Outcome was assessed using the Glasgow Outcome Scale (GOS) at 24 months. Aetiology, clinical features, therapeutic considerations and risk factors of poor outcome were analysed according to age. Data from 38 patients were studied; 33/38 presented with subdural empyema (SDE) and 5/38 with extradural empyema (EDE); 10/38 were infants <1 year of age with SDE, all related to bacterial meningitis; 28/38 were children, with 23/28 showing SDE and 5/28 EDE. Oto-sinogenic infections were the main causes in children. All infants recovered completely as did children with EDE. However, two out of 23 children with SDE had permanent neurological deficit, already detected on admission, and one out of 23 died. Thirty-three out of 38 were operated; 16 of which underwent multiple surgical procedure because of recurrence. Burr hole was performed in six infants and craniotomy in one, while 21/23 children underwent burr hole or craniotomy. Burr hole was more often associated with recurrence. In children with SDE, factors associated with poor outcome were neurological deficit (p = 0.002) and cerebral herniation on CT scan (p = 0.02) on admission. In this study, we gained further insights into modern epidemiology of PICE by highlighting age-related aetiology, symptoms, treatment strategy, and outcome differences. Meningitis was the main aetiology in the infants and sinusitis was prevalent in children. Finally, early diagnosis by neuro-imaging investigations and timely and appropriate multidisciplinary treatment may offer the best chance of recovery.

Intracranial suppuration complicating sinusitis among children: an epidemiological and clinical study

“…1,[25][26][27][28][29]31,[34][35][36][37][38][39][40][41][42][43][44][45][48][49][50][51][52][53][54][56][57][58][59][60] Many of these reports are inhomogeneous with respect to etiology, including infectious collections related to community-acquired meningitis, congenital heart disease, trauma, and previous surgery. Many reports limited to complications of sinusitis include orbital cellulitis, dural sinus thrombophlebitis, and meningitis, which were not considered in the current study.…”

Infantile Chronic Subdural Hematoma Infected by Escherichia Coli -Case Report-

“…3,13) In past large series, E. coli was responsible for 9.7% to 27% of cases. 3,8,13) Subdural hemorrhage in an infant has been considered to result from rupture of the cortical bridging veins, but recent investigation suggested a dural origin, as the intradural vessels, thin-walled and adapted for fluid resorption, may be the most likely to leak, resulting in bleeding into the dura and simultaneously forming a subdural hematoma either spontaneously or after an otherwise innocuous event. 12) Our patient had no apparent history of traumatic episodes.…”

Serial PCR genetic load determination in the surgical management of pneumococcal intracranial sepsis

“…Streptococcus pneumoniae commonly causes meningitis, although the literature also reveals subdural empyema [1][2][3] and brain abscess [4] secondary to this organism. There are multiple virulence factors which prognosticate for disease severity and the requirement of prolonged antibiosis.…”