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 Memo rial Children's Hospital between 1979 and 1998. Thirty-two were male a nd 13 female. The majority were between 13 and 19 years of age. Headac he was the predominant symptom in 41 patients. Vomiting occurred in 15 and 21 presented with seizures, 2 in status epilepticus. Thirty had s winging pyrexias and 26 neck stiffness while only 14 had focal neurolo gical signs. Swelling of the face or orbit was seen in 24. Twenty-two had depressed levels of consciousness and 7 had Glasgow-Coma Scale (GC S) values below 11/15. White cell counts and erythrocyte sedimentation rates were raised in all cases. Twenty-three patients underwent lumba r punctures despite the inherent danger in this procedure. Cerebrospin al 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 underw ent multiple burrholes, 9 small craniectomies and 11 craniotomies. Thi rty-four patients made an excellent recovery. AII of the 6 patients wh o died had GCS values below 11 at the time of their surgery.