[P3-31] Spontaneously Subdural Empyema in Infants with Subdural Hematoma
[Introduction] Subdural empyema is a serious neurological condition characterized by collection of purulent matter in the subdural space. It is usually secondary to infection from a contiguous site (sinusitis or otitis) in children or from bacterial meningitis in infants. Here we report a less frequent cause of spontaneously subdural empyema in 5 infants with preexisting subdural hematoma. [Results] The average age of these infants, 3 female and 2 male, was 5.5 month. The clinical manifestations were fever (100%), irritable crying (75%), seizures (50%), and bulging anterior fontanel (50%). Three infants had accidental head injury between 3 days to 1 month before admission. One infant could have been shaken. Two infants had urinary tract infection and 1 had acute enterocolitis. The pathogens were Escherichia coli in 2 infants, and Salmonella enterica in 1. Cerebrospinal fluid (CSF) from the subdural space shows pleocytosis, high protein and low glucose level. Subdural empyema was diagnosed by brain ultrasonography in all 4 infants. All infants received surgical drainage and antibiotics treatment for 4-6 weeks. The outcome (average 1.5 years) showed normal neurodevelopment in 3 cases and mild language delay in 1. [Conclusions] In contrast to bacterial meningitis, the neurological outcome for the infants with spontaneously subdural empyema is good. The physicians should be aware that subdural hematomas are potential sites for infection and may require surgical intervention. Subdural empyema must be considered in febrile infants with neurological manifestations and trauma history. Brain ultrasonography is a helpful tool for early diagnosis of subdural empyema in infants.