Thirty-two patients with subdural empyema at the University Hospital (Birmingham, AL) during the period from June 1970 through June 1992 were identified retrospectively. Clinical presentations of patients, methods of diagnosis, results of microbiological tests, types of therapy used, and outcomes of patients are presented and compared with those found in prior reports. The patients were separated into three groups based on the etiology of their disease: sinusitis, trauma and/or neurosurgery, and other miscellaneous causes. Sinusitis accounted for 56% of the cases; the predominant organisms isolated from these patients were anaerobes and streptococci. No cases occurred secondary to otitis media. The overall mortality rate was 9%; however, 55% of patients had neurological deficiency at the time they were discharged from the hospital. Factors that affected survival were age (P <.007) and level of consciousness at presentation (P <.008). © 1995 by The University of Chicago. All rights reserved.