Subdural empyema (SDE) is a rare form of intracranial sepsis that can rapidly lead to death. This fatal outcome is potentially preventable if the diagnosis is made at an early phase of the disease process and appropriate treatment measures are implemented in time. A case series of 6 patients is presented, illustrating the difficulties encountered in the diagnosis and treatment of SDE. The pathoanatomical basis of SDE is highlighted, and management challenges encountered in treating the condition, namely, difficulties hindering early diagnosis and controversies in optimal surgical approach, are addressed.