In more severe cases signs of increased intracranial pressure may be evident. CT scanning is the most efficient diagnostic method. Lumbar puncture usually reveals CSF pleocytosis and abnormalities of CSF glucose and protein. Both EEG and radionuclide brain scans are too nonspecific to have any true diagnostic value. The most common organisms isolated from subdural empyemas include staph aureus, strep pneumonia, and anaerobes.
Treatment mandates the surgical drainage of the paranasal sinuses and any intracranial abscesses.
Antibiotics should be chosen to cover the most common organisms. Most authors recommend an initial antibiotic regimen including a combination of penicillin G, a penicillinase- resistant penicillin, and chloramphenicol. Other complications associated with sinusitis include orbital cellulitis, orbital abscess, subperiosteal abscess, and cavernous sinus thrombosis.