Intracranial subdural empyema (ISDE) is relatively uncommon. An even more uncommon subset involves a parafalcine ISDE. The diagnosis may be delayed for weeks.
Intracranial subdural empyema is a suppurative infection in the space between the dura and the arachnoid membrane. Parafalcine ISDE is one limited to the region of the falx cerebri.
Causes may include:
(1) otitis media
(2) bacteremia
Common clinical findings may include:
(1) fever
(2) headache
(3) falx syndrome, with a seizure starting in the contralateral lower extremity with weakness and/or secondary generalization
(4) vomiting
(5) altered consciousness secondary to raised intracranial pressure
The course may be indolent if spread of the infection is limited by adhesions. Infection may spread on both sides of the tentorium.
Imaging with MRI is helpful in localizing the infection and for planning management.
Therapy consists of controlling the cause, initiating antibiotic therapy and sometimes drainingthe pus.
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