Overview
Subdural abscess is a collection of pus within the subdural space, often complicating acute subdural hematoma (SDH) and potentially leading to neurological deficits and severe morbidity 5. It can arise from various etiologies including trauma, vascular anomalies, and complications from medical procedures 1346.Diagnosis
Clinical Presentation: Acute onset of encephalopathy, seizures, and focal neurological deficits 15.
Imaging: CT or MRI is essential for diagnosis, showing characteristic collections of fluid with possible mass effect 5.
Differential Diagnosis: Exclude non-accidental injury, vascular lesions (e.g., aneurysms), and complications from procedures like spinal anesthesia 136.
Laboratory Tests: Not specific but may show elevated white blood cell count and inflammatory markers 5.Management
Surgical Intervention: Evacuation of the abscess and associated hematoma is often necessary 56.
Antibiotics: Broad-spectrum antibiotics tailored to culture results; specific drug classes and doses not detailed in abstracts 5.
Neurological Support: Management of seizures with antiepileptic drugs if present 2.
Monitoring: Close neurological monitoring post-surgery to manage complications 5.Special Populations
Pediatrics: Consider non-accidental injury but also vascular causes like aneurysms 1.
Elderly: Susceptible to subdural hematoma post-spinal anesthesia, requiring vigilance for delayed complications 6.
Comorbidities: Patients on antiplatelet or anticoagulant therapy require careful evaluation to exclude subdural hematoma before initiating new therapies 5.Key Recommendations
Exclude Non-Accidental Injury: In pediatric cases with subdural hemorrhage, thoroughly investigate for non-accidental injury but consider alternative causes like vascular anomalies 1. (Evidence: Moderate)
Imaging for Diagnosis: Use CT or MRI to diagnose subdural collections and guide management decisions 56. (Evidence: Strong)
Surgical Evacuation: For significant subdural abscess or hematoma with neurological compromise, surgical evacuation is recommended 56. (Evidence: Moderate)
Consider Post-Procedure Complications: In elderly patients undergoing spinal anesthesia, monitor for delayed subdural hematoma 6. (Evidence: Weak)
Evaluate for Transient Neurological Deficits: Subdural hematoma should be considered in elderly patients presenting with transient neurological deficits 5. (Evidence: Moderate)References
1 Silva AHD, Gander L, Wijesinghe H, Rodrigues D. Spontaneous neonatal subdural haemorrhage: always non-accidental injury?. British journal of neurosurgery 2020. link
2 Won SY, Konczalla J, Dubinski D, Cattani A, Cuca C, Seifert V et al.. A systematic review of epileptic seizures in adults with subdural haematomas. Seizure 2017. link
3 McDougall RJ, Barnes R, Danks RA, Ditchfield M. Subdural haematoma following infant spinal anaesthesia. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery 2016. link
4 Sunkaraneni VS, Banerjee A, Gray RF. Subdural haematoma: a complication of cochlear implantation. The Journal of laryngology and otology 2004. link
5 Cher LM, White OB. Subdural haematoma presenting with transient neurological deficits. The Medical journal of Australia 1992. link
6 Rudehill A, Gordon E, Rähn T. Subdural haematoma. A rare but life-threatening complication after spinal anaesthesia. Acta anaesthesiologica Scandinavica 1983. link