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 Volume 69, Number 05, July 31, 2007
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NEUROLOGY 2007;69:477-481
© 2007 American Academy of Neurology

The clinical challenge of recognizing infratentorial empyema

Diederik van de Beek, MD, PhD, Norbert G. Campeau, MD and Eelco F.M. Wijdicks, MD, PhD

From the Division of Critical Care Neurology (D.v.d.B., E.F.M.W.), Department of Neurology, and Division of Neuroradiology (N.G.C.), Department of Radiology, Mayo Clinic College of Medicine, Rochester, MN.

Address correspondence and reprint requests to DrM. Wijdicks, Department of Neurology, Mayo Clinic College of Medicine, W8B, 200 First Street SW, Rochester, MN 55905 wijde{at}mayo.edu

Background: Infratentorial empyema is an uncommon complication of bacterial meningitis. Very little is known about its recognition and appropriate management.

Method: We present a patient with infratentorial subdural empyema and compare findings with 41 cases with infratentorial empyema reported in the literature.

Results: Many patients with infratentorial empyema presented as subacute meningitis with neck stiffness and decreased consciousness. Diagnosis was often delayed. The minority had cerebellar findings and cranial nerve deficits. Clues to the diagnosis were presence of otitis, sinusitis, or mastoiditis and recent surgery for these disorders. The majority of patients underwent craniotomy; conservative treatment with antibiotics was associated with relapse of symptoms. The mortality rate was high especially in those with subdural empyema. CT failed to clearly visualize infratentorial subdural empyema in several reported cases.

Conclusions: Infratentorial empyema is a life-threatening rare complication of bacterial meningitis. MRI, including diffusion-weighted imaging, is the preferred imaging technique in patients with suspected or proven bacterial meningitis and associated ear-nose-throat infection with deterioration in consciousness and neurologic signs that suggest a posterior fossa lesion. Neurosurgery should be regarded as first choice therapy.

D.v.d.B. is supported by personal grants from the Meerwaldt Foundation and the Netherlands Organization for Health Research and Development (ZonMw), NWO-Rubicon grant 2006 (019.2006.1.310.001), and NWO-Veni grant 2006 (916.76.023).

Disclosure: The authors report no conflicts of interest.

Received November 29, 2006. Accepted in final form March 2, 2007.




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Community-acquired bacterial meningitis in adults
Practical Neurology, January 1, 2008; 8(1): 8 - 23.
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