Fact-sheet: Empyema of brain
Updated on 09/17/2021 at 12:16 PM
View all RADEOS cases associated with this fact-sheet
Definition
Extra-axial collection (subdural or epidural) with purulent content, of infectious origin
Clinical features
Headache and clinical-biological inflammatory syndrome.
Meningeal syndrome.
Febrile confusion.
Focal neurological deficit depending on location.
Signs of herniation.
Sinusitis (if naso-sinus origin)
Laboratory findings
biological inflammatory syndrome
CT
Extra-axial collection (subdural or epidural), spontaneously iso- to hyperdense.
Intense peripheral enhancement of the collection and of the lepto-pachymeninges.
MRI
T1: collection of variable signal.
T2 FSE and FLAIR:
collection of variable signal,
hyperintensity of the adjacent cerebral parenchyma.
Thickening of the lepto-pachymeninges adjacent to the collection.
Diffusion:
hyperintensity of the collection with decreased ADC.
Post-contrast T1:
marked enhancement of the pachy-leptomeninges adjacent to the collection.
Possible enhancement of the adjacent cerebral parenchyma (encephalitis, abscess) and/or of the ventricular walls (ventriculitis).
Management
Neurosurgical evacuation and appropriate antibiotic therapy (intraoperative sampling, blood cultures)
Differential diagnosis
Chronic subdural hematoma:
Different clinical setting.
Hematoma signal on MRI.
Peripheral enhancement possible but thinner and less intense.
Hygroma:
post-traumatic setting.
No wall enhancement.
Dural metastasis:
known primary tumor (breast and prostate most often).
Often diffuse involvement with enhancing nodules.
Associated with intra-parenchymal or bone metastases
