Management of epidural abscesses and subdural empyemas

Epidural abscesses (EA) and subdural empyemas (SE) are intracranial infections that occur in the potential spaces between the skull and brain. Both are most commonly caused by direct extension of infection from sinus disease or by contamination incurred during craniotomy. Patients can manifest a spectrum of clinical symptoms ranging from subtle changes postoperatively to rapid neurological deterioration associated with fever. Diagnosis is confirmed with computed tomography or magnetic resonance imaging with contrast. Urgent surgical treatment is usually indicated because both are potentially life-threatening conditions. Empirical antibiotic therapy, followed by tailoring of therapy after identification of the organism, is an absolute necessity. Because improved patient outcomes are associated with early detection and prompt treatment of epidural abscesses and subdural empyemas, physicians should have a high level of suspicion for their presence and pursue their diagnosis and treatment expeditiously.