Rhinogenic subdural empyema in older children and teenagers.

Forty-five patients under the age of 20 years with rhinogenic subdural empyema were treated at Groote Schuur Hospital and Red Cross War Memorial Children's Hospital between 1979 and 1991. Thirty-two were male and 13 female. The majority were between 13 and 19 years of age. Headache was the predominant symptom in 41 patients. Vomiting occurred in 15 and 21 presented with seizures, 2 in status epilepticus. Thirty had swinging pyrexias and 26 neck stiffness while only 14 had focal neurological signs. Swelling of the face or orbit was seen in 24. Twenty-two had depressed levels of consciousness and 7 had Glasgow Coma Scale (GCS) values below 11/15. White cell counts and erythrocyte sedimentation rates were raised in all cases. Twenty-three patients underwent lumbar punctures despite the inherent danger in this procedure. Cerebrospinal fluid analysis showed a pleocytosis in all cases; no organisms were cultured in any of the specimens. The diagnosis in all cases was made by contrast-enhanced computed tomography. Twenty-five patients underwent multiple burrholes, 9 small craniectomies and 11 craniotomies. Thirty-four patients made an excellent recovery. All of the 6 patients who died had GCS values below 11 at the time of their surgery.