title: Infantile subdural empyema: The role of brain sonography and percutaneous subdural tapping in a resource-challenged region.
abstract: BACKGROUND
  This study explored the outcome of children with patent anterior fontanelles who were treated with trans-fontanelle ultrasound scan (TFUSS), which is more affordable and available than CT scan and MRI in the diagnosis of childhood intracranial pathologies and treatment of subdural empyema, in developing countries.
  
  
  METHODS
  Seventeen infants with post-meningitic subdural empyema, diagnosed using trans-fontanelle ultrasound alone and treated with subdural tapping over a 31-months period, were studied.
  
  
  RESULTS
  Eleven patients presented with grades II and III Bannister and William grading for level of consciousness in intracranial subdural empyema. Aspirate from 7 (41.2%) patients were sterile. The most common organisms isolated were Streptococcus faecalis 3 (17.6%), Haemophilus Influenza 2 (11.8) and Staphylococcus aureus 2 (11.8), multiple organisms were isolated in three of the patients. Ninety-four percent (94%) of the patients had good outcome. Five subjects developed hydrocephalus, one patient had a recurrence of subdural empyema, four patients had residual hemiparesis, two of the four patients had speech difficulties, while one patient (~6%) died.
  
  
  CONCLUSIONS
  While CT and MRI remain the gold standard for investigating intracranial lesions, transfontanelle ultrasonography is adequate for diagnosis of infantile subdural empyema in resource-challenged areas. Percutaneous subdural tap is an affordable and effective therapy in such patients with financial challenges.
authors.affiliation: Department of Surgery, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
authors.forename: Okezie Obasi
authors.initials: OO
authors.lastname: Kanu
authors.affiliation: Department of Paediatrics, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
authors.forename: Chinenye
authors.initials: C
authors.lastname: Nnoli
authors.affiliation: Department of Radiodiagnosis, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
authors.forename: Omodele
authors.initials: O
authors.lastname: Olowoyeye
authors.affiliation: Department of Surgery, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
authors.forename: Omotayo
authors.initials: O
authors.lastname: Ojo
authors.affiliation: Department of Paediatrics, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
authors.forename: Christopher
authors.initials: C
authors.lastname: Esezobor
authors.affiliation: Department of Radiodiagnosis, College of Medicine, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
authors.forename: Adekunle
authors.initials: A
authors.lastname: Adeyomoye
authors.affiliation: Department of Surgery, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
authors.forename: Olufemi
authors.initials: O
authors.lastname: Bankole
authors.affiliation: Department of Surgery, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
authors.forename: Chinyere
authors.initials: C
authors.lastname: Asoegwu
authors.affiliation: Department of Paediatrics, University of Lagos and Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria.
authors.forename: Edamisan
authors.initials: E
authors.lastname: Temiye
keywords: Cranial sonography; subdural empyema; subdural taps; transfontanelle ultrasonography