Subdural empyema

Case contribution: Dr Radhiana Hassan


  • A 13 years old girl
  • Had underlying rhinosinusitis
  • Presented with fever, headache and vomiting for one week
  • Initially treated as AGE and sinusitis
  • In ward noted to have left eye lateralization and limb weakness

MRI findings:

  • A subdural right para-falcine collection
  • Hypointense on T1, hyperintense on T2/FLAIR with peripheral enhancement post contrast.
  • It showed restricted diffusion on DWI/ADC sequences
  • minimal mass effect is seen onto the adjacent cerebral parenchyma
  • minimal effacement of the right cerebral hemisphere
  • Cavernous and dural venous sinuses are normal.

Diagnosis: Parafalcine subdural empyema

Progress of patient:

  • Burrhole drainage done, about 25-30 cc pus gushed out upon opening of dura.
  • Pus culture no growth, pus cells 3+, epithelial cells 1+, no organism seen, AFB smear negative
  • Responded well with antibiotics


  • Subdural empyema is a collection of pus between the dura mater and underlying arachnoid mater.
  • It is usually a complication of sinusitis or following an ear infection, cranial trauma or surgery and rarely bacteraemia.
  • The most common causative organisms are streptococci.
  • It may progress to meningitis, cortical vein thrombosis or brain abscess.
  • On imaging it presents as crescentic collection with meningeal enhancement.
  • CT shows similar appearance to subdural haematomas in their shape and relationship with dural reflections.
  • MRI may show restricted diffusion.
  • Mortality rate is reported about 10%.
Author: radhianahassan