Subdural empyema. Clinical and computed tomographic correlations.

The clinical and computed tomographic (CT) findings in 15 patients with subdural empyema (SDE) were analyzed. Seven children with meningitis later developed focal neurologic signs of SDE. The CT scans showed prominent subdural lesions with medial membrane enhancement; only one child had a parenchymal lesion, which represented a brain abscess. Two lesions were multiloculated, which was delineated by the CT finding of medial enhancing bands separating the compartments of the hypodense lesions. Of eight adolescents and adults with SDE, seven had sinusitis. These patients presented initially with fever and meningeal signs in addition to altered levels of consciousness. They latter developed focal neurologic signs or seizures. In seven cases, CT showed hemispheric mass effect with a thin subdural lesion and a medial enhancing membrane. One scan showed a prominent subdural lesion with minimal hemispheric mass effect.