Intracranial subdural abscess

Abstract

Thirty-two cases of intracranial subdural abscess were treated between 1947 and 1969 in two neurosurgical centres. Five patients (15.6 per cent) died. When an E.N.T. focus is detected clinically or radiologically the abscess is always related to it. Four of the 5 fatalities harboured pus along the falx cerebri. Angiography is used to aid localization and to detect further collection of pus. Limited experience in the use of gamma scanning for localization is encouraging. Pus in the subdural space is drained through bur-holes and antibiotics are administered locally. Broadspectrum bactericidal antibiotics are used in high dosage as the initial treatment and cerebral oedema is controlled by mannitol and dexamethasone in the drowsy or unconscious patient. Surgical decompression should be considered when comatose patients do not respond to bur-hole drainage of the pus and medical measures.