[Analysis of subdural intracraneal empyemas in a third level hospital].
Intracranial subdural empyema (ISE) is an infrequent infectious disorder of diverse etiology and difficult to diagnose because of its non-specific clinical features. Retrospective study of patients diagnosed of ISE in a third-level university hospital in a 15-year period. Five men were included (mean age: 39.3 years). The most frequent primary source of infection was otic and sinusal (60%). The initial clinical manifestations were fever, headache, alteration of consciousness, and neurological focal symptoms. The mean time elapsed between onset of symptoms and diagnosis was 3.6 days. Diagnosis was performed by computed tomography in all patients. ISE was localized in the left hemisphere in 60% of cases mainly affecting the parietal lobe (80%). Anaerobic and streptococci germs were the most frequently isolated microorganisms. Therapy was based on antibiotics and surgical drainage in 100% of the cases. The surgical procedure used in the evacuation of empyema was craniotomy in all the patients. The mean time elapsed between diagnosis and surgery was 8.4 days. The mean Intensive Care Unit stay was 12.8 days, whereas the overall mean in-hospital stay was 45.2 days. Mortality was 40%. ISE, although infrequent, displays a high morbimortality that can be reduced with an early therapeutic approach which may include the surgical evacuation in all the cases.