Extensive subdural empyema treated with drainage and barbiturate therapy under intracranial pressure monitoring: case report.
In subdural empyema (SDE), if the mass effect and vasogenic edema are not controlled, the brain can be fatally damaged. Massive SDE over the skull base often requires repeated surgical drainage for removal of accumulated pus. Intracranial pressure (ICP) management until obliteration of the empyema is important to the improvement of clinical outcome. An 18-year-old man was admitted to our center in a nearly comatose state and with a mild fever. CT scan showed massive SDE extending to the skull base and parafalx. ICP was measured with a pressure transducer through an intraventricle tube. Repeated surgical drainage was performed while ICP was controlled with barbiturate therapy. He was discharged with no neurological deficits. In patients with an extensive SDE over the cerebral hemisphere, ICP control with barbiturate therapy may enhance the therapeutic effect of surgical drainage.
Kageyama
G
G
Osaka Prefectural Senshu Critical Care Medical Center, Japan.
Park
K C
KC
Yoshimine
Y
Y
Yokota
J
J
D000293:Adolescent; D001463:Barbiturates / Q000627:therapeutic use*; D001921:Brain / Q000000981:diagnostic imaging; D003128:Coma; D004322:Drainage; D013354:Empyema, Subdural / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005334:Fever; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D008991:Monitoring, Physiologic; D014057:Tomography, X-Ray Computed
D001463:Barbiturates