This document describes a case study of a 75-year-old male patient who presented with pus discharge from a previous burr hole site wound for 1 week, along with low grade fever and headache for 1 week. The patient had a history of right frontal burr hole, parietal limited craniectomy and evacuation of chronic subdural hematoma in 2002 and 2004, with post-operative CSF leak. On examination, the patient was conscious with no neurological deficits and normal fundus. Pus culture grew Pseudomonas sensitive to amikacin and ciprofloxacin. The patient underwent right fronto-parietal craniotomy and evacuation of pus and excision of outer membrane. The

1. Dr.M.Manoranjitha kumari
Madras Institute Of Neurology
Chennai

2. Case
• 75 years male
• Admitted on 6/07/10
• c/o pus discharge from prvious burr hole site wound
for 1 week
• Low grade continuous fever- 1 week
• Head ache – 1 week
• No limb weekness, fits, LOC
• Non DM TB

3. 29/09/2002
Under LA right
frontal burrhole,
parietal limited
craniectomy and
evacuation of
chronic SDH done
Post op CSF leak
and secondary
suturing done

4. 27/04/2002
Retapping of
chronic SDH
29/05/03
Granulation tissue
excision from right
parietal burr hole

5. On examination:
Conscious, no neurological deficit, fundus normal
Pus discharge from frontal burr hole site

7. Right fronto parietal craniotomy and evacuation of
pus and excision of outer membrane

12. Pus culture – pseudomonas , sensitive to amik, cipro

13. Post op

14. Discussion
Incidence
66%- prior craniectomy
29%-sinusitis, CSOM
11- years study -47 patients(retrospective analysis)
JNS-1994 june 34
Intracranial suppuration –a modern decade of post op suppurative
empyema, epidural abscess– hlavin et al, university hospital
cleveland, ohio

15. Subdural empyema from chronic SDH 1%
50% in patients undergo repeated surgery
Calcification of chronic subdural empyema-rare, till
2006 4 cases( neurosurgery quarterly sep 2006 vol 16 152-
154)

16. • Usually unilateral
• Limited by specific boundaries like falx,
tentorium, base of brain and foramen magnum
• Behaves expanding mass– increase ICP, cerebral
parenchymal penetration, cerebral edema and
hydrocephalus due to disruption of blood and CSf
flow by elevated ICP
• Infarction- thrombosis of cortical veins
• Septic venous thrombosis of contiguous veins in
subdural empyema

17. Anaerobic aerobic streptococci
Following cranial surgery- staph aureus
Mortality- 18.5%

18. Thank you