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NeuroSurgery Conference

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

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  1. NeuroSurgery Conference Clerk June 11, 2010 2-3 PM

  2. ASSESSMENT • Left Fronto-Parietal Subdural Empyema secondary to left frontal sinusitis

  3. DISCUSSION

  4. 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

  5. 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

  6. CNS INFECTIONS • Three locations where infection may occur: • Subarachnoid Space • Subdural Space • Epidural Space

  7. 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

  8. CARDINAL MANIFESTATIONS

  9. SUBDURAL EMPYEMA • Collection of pus between the dura and arachnoid membranes

  10. 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

  11. ETIOLOGY

  12. SIGNS AND SYMPTOMS • Hx of Chronic sinusitis or mastoiditis

  13. LABORATORY FINDINGS

  14. MRI

  15. 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

  16. PROGNOSIS • Influenced by the ff: • Level of consciousness at hospitalization • Size • Time of intervention

  17. THANK YOU

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