From minor infection to major infection: subdural empyema explained

Subdural empyema is a rare, but life-threatening and rapidly progressing infection which causes a pus collection between the dura and arachnoid matter in the brain, potentially resulting in significant long-term neurological complications, and even death.

The specialist sepsis team at Penningtons Manches Cooper represents a number of clients whose lives have been profoundly affected by subdural empyema. These individuals have presented to A&E with red flag signs of progressing sinusitis and/or pre-septal cellulitis and due to failings in their care, the infection has spread and resulted in subdural empyema.

What is subdural empyema?

The brain is surrounded by several thin layers of tissue that protect it. Subdural empyema occurs when pus builds up between two of these layers because of an infection. This trapped infection can quickly cause pressure on the brain, and that pressure can rise at a dangerous speed. Although the condition is rare, it is a medical emergency.

Subdural empyema can lead to lasting neurological damage and result in:

1. recurring seizures such as epilepsy;
2. speech problems;
3. difficulties with memory and problem solving;
4. long stays in intensive care;
5. lifelong disability such as weakness or partial paralysis, usually on one side of the body;
6. in some situations, death.

Red flag infection symptoms requiring urgent treatment

Subdural empyema can occur when severe cases of sinusitis and pre-septal cellulitis are not appropriately treated, allowing the infection to spread and affect the brain.

Sinusitis: this is the swelling of the sinuses caused by an infection. The main symptoms include pain and swelling in the eyes, a blocked or runny nose, a reduced sense of smell, and a high temperature. Whilst it often resolves on its own, sometimes treatment is required, and this is particularly so if objective (visible) facial swelling is noted. Visible facial swelling suggests the infection has progressed behind the eye and so urgent assessment and treatment, often in the form of IV antibiotics, is needed.

Pre-septal cellulitis: this is an infection of the eyelid and the soft tissue around the eye which causes swelling and redness, with the skin around the eye often feeling warm to the touch. Unlike sinusitis which often resolves on its own, pre-septal cellulitis usually requires oral antibiotics to prevent it from spreading. If after 48 hours there has been no improvement in symptoms and movement of the eye causes pain (a red flag symptom), it becomes a medical emergency, as these symptoms suggest the infection has started to spread behind the eye.

The importance of awareness

Greater awareness about conditions like subdural empyema can help save lives. If patients, families, and clinicians are able to recognise when symptoms have gone beyond a routine infection, urgent action can be taken which is crucial for ensuring the best possible outcome. Even a short delay can lead to serious, long-term problems, and make it harder to return to work and manage everyday activities.

If you have been affected by any of these issues, our specialist medical negligence team may be able to help. Please contact us on 0800 328 9545, e-mail clinnegspecialist@penningtonslaw.com or complete our online assessment form.