Epidural empyema

Epidural empyemas are relatively rare, but acount for ca. 30% of all intracranial infections. They can appear at every age with no sex preference.

The most common pathogens are streptococci, Haemophilus influenzae, Staphylococcus aureus and Staphylococcus epidermidis.

In more than 2/3 of cases epidural empyemas are a complication of sinusitis. Spreading can be per continuitatem through the sinus walls or retrograde through valve-less bridging veins.

Approximately 20% of cases are complications of mastoiditis. Epidural empyemas can occur as a complication of traumatic brain injury, neurosurgical operations or meningitis.

Fever, headache, meningism, sinusitis.

Focal-neurologic deficits or seizures can occur in cases of large, space-consuming empyemas. 

Biconvex, bounded by sutures, can cross thr midline.

Extra-axial, liquorisodense or hyperdense space-consuming lesion, lensoid / biconvex.

Strong peripheral contrast enhancement.

  • T1: Hyperintense
  • T2/PD: Iso- or hyperintense
  • FLAIR: Hyperintense
  • DWI: Pus is hyperintense with decreased ADC
  • T1 + Gd: strong peripheral contrast enhancement

Lethality: 10-15%. 

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rID: 16509
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    Case 1: Sinugenic, C+ delayed
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