A retrospective study of 28 patients identified with subdural empyema ( SE) at the Department of Neurosurgery between the years 1995 and 2005 was carried out. SE occurred in all patients following bacterial meningitis. The six most frequently encountered clinical features included: ( 1) fever in 22 (79%) patients; ( 2) disturbed consciousness in 16 (57%) patients; ( 3) papilledema in 11 (39%) patients; ( 4) hemiparesis in 4 (14%) patients; ( 5) meningismus or meningeal signs in 4 ( 14%) patients, and ( 6) seizures in 3 (11%) patients. In the majority of cases, the most frequent causative pathogen of SE was Staphylococcus aureus. Surgery was performed on all patients, which included craniotomy in a group of 20 patients and burr hole drainage in a group of 8 patients. In conclusion, we believe that infants and young children should be carefully monitored following meningitis, in case of SE development, and that surgical intervention in patients presenting with meningitis may facilitate the development of SE. Furthermore, from a surgical point of view, our experience has led us to believe that craniotomy in comparison with burr hole surgery is the best surgical modality for management of SE as the recurrence rate of SE associated with burr hole surgery is high. Copyright (c) 2006 S. Karger AG, Basel.