Subdural Empyema in the Setting of Multimodal Intracranial Monitoring.
BACKGROUND
Multimodal intracranial monitoring is becoming an increasingly common tool in the management of patients with traumatic brain injury. Although numerous reports detailing the benefits of such advanced monitoring exist in the literature, there is minimal discussion of the possible complications that may arise in this patient population.


METHODS
We report the case of a 32-year-old patient who had been assaulted and presented initially at an outside facility with a Glasgow Coma Scale score of 8. After transfer to our hospital, his Glasgow Coma Scale score was noted at 7T and multimodal monitoring with the Integra Licox brain tissue oxygen monitor and the Hemedex Bowman perfusion monitor was implemented, along with an external ventricular drain when a standard intracranial pressure monitor indicated increasing intracranial pressure. The patient's intracranial pressure normalized but he did require a course of antibiotics during this time for a fever and methicillin-resistant Staphylococcus aureus. The patient subsequently developed multifocal subdural empyemas requiring surgical evacuation. Postoperatively, the patient's intraoperative cultures remained without bacterial growth, likely related to the 2-week broad-spectrum antibiotic use.


CONCLUSIONS
To our knowledge, this is the first reported incidence of a subdural empyema developing in this setting. Although the safety profile of multimodal intracranial modeling is excellent, with increasing numbers of invasive bedside procedures, neurosurgeons must remain acutely vigilant for the development of infectious complications.
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
Jian
J
Guan
Division of Infectious Disease, Department of Internal Medicine, University of Utah Medical Center, Salt Lake City, Utah, USA.
Emily S
ES
Spivak
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
Christopher
C
Wilkerson
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA. Electronic address: neuropub@hsc.utah.edu.
Min S
MS
Park
D000328:Adult; D001921:Brain / Q000098:blood supply*; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis* / Q000503:physiopathology* / Q000601:surgery; D002557:Cerebrospinal Fluid Shunts; D003428:Cross Infection / Q000209:etiology* / Q000503:physiopathology* / Q000601:surgery; D038524:Diffusion Magnetic Resonance Imaging; D013354:Empyema, Subdural / Q000209:etiology* / Q000503:physiopathology* / Q000601:surgery; D015600:Glasgow Coma Scale; D006408:Hematoma, Subdural / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D007362:Intensive Care Units; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D007427:Intracranial Pressure / Q000502:physiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008991:Monitoring, Physiologic / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D010100:Oxygen / Q000097:blood*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed
D010100:Oxygen
Complications; Infection; Multimodal intracranial monitoring; Subdural empyema; Traumatic brain injury