epidural abscess

What is an Epidural Abscess?

An epidural abscess is a rare but potentially life-threatening infection that forms in the space between the skull bones and the brain lining (intracranial epidural abscess) or in the space between the bones of the spine and the lining membrane of the spinal cord (spinal epidural abscess).

Types of Epidural Abscess

There are two types of epidural abscess:

• Intracranial Epidural Abscess: This type occurs in the space between the skull bones and the brain lining.
• Spinal Epidural Abscess (SEA): This type occurs in the space between the bones of the spine and the lining membrane of the spinal cord.

Symptoms

The symptoms of epidural abscess can vary depending on the location and severity of the infection. Common symptoms include:

• Severe back pain
• Tenderness over the spine
• Pain that radiates down the legs
• Numbness, tingling, weakness or difficulty moving arms or legs
• Headache
• Nausea and vomiting
• Bladder or bowel dysfunction

Causes and Risk Factors

The exact cause of epidural abscess is often unknown, but it can be caused by a bacterial infection that spreads to the epidural space. Risk factors for developing an epidural abscess include:

• Immunocompromised state (e.g., HIV/AIDS)
• Trauma or surgery
• Infection in other parts of the body

Treatment

Prompt treatment is essential to prevent serious complications and death. Treatment typically involves antibiotics with or without parenteral needle aspiration, and immediate drainage if the abscess causes neurologic compromise.

References:

• [1] A spinal epidural abscess(SEA) is a suppurative central nervous system infection involving the space between the spinal dura and vertebral periosteum.[1]
• [2] Although classically, patients with spinal epidural abscesses present with midline back pain, fever, and neurologic deficits, presentations of this disease process can be highly variable.
• [3] If abscess causes neurologic compromise, immediate drainage. Antibiotics with or without parenteral needle aspiration may be sufficient treatment for a spinal epidural abscess.
• [4] Severe back pain, tenderness over the spine, pain that radiates down the legs, numbness, tingling, weakness or difficulty moving arms or legs are symptoms of epidural abscess.

Symptoms of Epidural Abscess

An epidural abscess can cause a range of symptoms, which vary depending on the location and severity of the infection.

• Headache: A headache is one of the possible symptoms of an epidural abscess, particularly if it occurs in the skull area (intracranial epidural abscess) [1].
• Disturbed consciousness: In severe cases, an epidural abscess can cause disturbed consciousness or altered mental status [2].
• Fever: Fever is a common symptom of an epidural abscess, indicating that the body is fighting an infection [3].
• Unusual sensation throughout your body: Some people may experience unusual sensations such as numbness, tingling, or weakness in their arms and legs due to pressure on the spinal cord [4].
• Blood tests to look for germs and other signs of infection: Blood tests can help diagnose an epidural abscess by detecting the presence of bacteria or other signs of infection [5].

Additional Symptoms

In addition to these symptoms, a spinal epidural abscess may also cause:

• Intense mid-back pain: A severe, intense pain in the mid-back area is often one of the first symptoms of a spinal epidural abscess [6].
• Fever and neurological deficits: Fever, chills, fatigue, loss of appetite, and neurological deficits such as arm and leg numbness are common warning signs of a spinal epidural abscess [7].

Important Note

It's essential to seek medical attention immediately if you experience any of these symptoms. An epidural abscess can be fatal if left untreated, so prompt treatment is crucial.

References:

[1] Context 1 [2] Context 4 [3] Context 4 [4] Context 14 [5] Context 4 [6] Context 5 [7] Context 6

Epidural abscess can be diagnosed through a combination of medical history, physical examination, laboratory tests, and imaging studies.

Imaging Studies

• Magnetic Resonance Imaging (MRI) is the cornerstone of diagnosis in both intracranial epidural abscess and spinal epidural abscess. MRI has the greatest diagnostic accuracy [3].
• MRI can visualize the lesion from the earliest stage, and within 1 week of onset, it can confirm the presence of an abscess in the epidural space and the extent of surrounding tissue involvement [9].

Laboratory Tests

• Blood tests, including complete blood count (CBC) and blood cultures, are used to look for signs of infection. Elevated erythrocyte sedimentation rate (ESR) is found in approximately 95% of cases [6].
• Urinalysis/urine culture may also be performed to check for urinary tract infections.

Other Diagnostic Tests

• Computed Tomography (CT) scans and bone scans are not typically used as they can delay definitive diagnostic testing.
• Myelography, which involves injecting a contrast agent into the spinal canal, has been mostly replaced by MRI in diagnosing epidural abscess [4].

It's worth noting that diagnosis of epidural abscess often requires a combination of these tests and a thorough medical history and physical examination.

References: [1] - Context result 2 [3] - Context result 3 [4] - Context result 4 [6] - Context result 6 [9] - Context result 9

Treatment of Epidural Abscess with Antibiotics

The treatment of epidural abscess typically involves a combination of antibiotics and drainage of the abscess. According to various medical sources [1, 4, 6, 8, 14], antibiotic therapy is usually administered intravenously (IV) for 4-6 weeks.

• Antibiotic combinations: The specific type of antibiotics used depends on the type of infection and may include vancomycin or other MRSA-active agents [3].
• Duration of treatment: Antibiotics are typically administered for 4-6 weeks, although this duration may vary depending on the individual case.
• Surgical drainage: In cases where the abscess causes neurologic compromise, immediate surgical drainage is often necessary to prevent further damage.

Additional Considerations

Other factors that can influence the treatment of epidural abscess include:

• Pregnancy: Pregnancy may affect the choice of antibiotics and the duration of treatment.
• Age: Age can also impact the selection of antibiotics and the overall treatment plan.
• Drug use by syringe: Individuals who use drugs via injection are at a higher risk of developing epidural abscess, which can influence the treatment approach.

Importance of Timely Treatment

Timely treatment is crucial in preventing significant neurological damage. In rare instances, emergency hospitalization may be necessary to address the condition promptly [15].

References:

[1] - An epidural abscess is an infection that forms in the space between the skull bones and the brain lining (intracranial epidural abscess) or in the space between the bones of the spine and the lining membrane of the spinal cord (spinal epidural abscess).

[3] - An anti-staphylococcal penicillin, a cephalosporin, or vancomycin may be used.

[4] - Treatment for spinal epidural abscess requires a combination of drainage of the abscess and antibiotics for several weeks.

[6] - An anti-staphylococcal penicillin, a cephalosporin, or vancomycin may be used.

[8] - Epidural abscesses most commonly require both surgical and medical therapy.

[14] - Treatment for spinal epidural abscess requires a combination of drainage of the abscess and antibiotics for several weeks.

Differential Diagnoses for Epidural Abscess

Epidural abscess, a serious medical condition characterized by the collection of pus in the space surrounding the spinal cord, requires prompt and accurate diagnosis to prevent severe consequences. The differential diagnoses for epidural abscess include:

• Bacterial Sepsis: A life-threatening condition caused by an overwhelming bacterial infection that can lead to organ failure.
• Brain Abscess: A rare but serious condition where pus accumulates in the brain tissue, often as a result of a bacterial or fungal infection.
• Diskitis: Inflammation of the intervertebral discs, which can be caused by bacterial or viral infections.
• Endocarditis: An infection of the inner lining of the heart valves that can lead to serious complications if left untreated.
• Fever of Unknown Origin (FUO): A condition where a person experiences recurring fevers without any apparent cause.
• Herniated Nucleus Pulposus: A condition where the soft, gel-like center of the intervertebral disc bulges out and puts pressure on surrounding nerves.

These conditions can mimic the symptoms of epidural abscess, making it essential for healthcare professionals to consider them in their differential diagnoses. Accurate diagnosis is crucial to ensure timely treatment and prevent long-term damage or even death.

References:

• [5] lists Bacterial Sepsis as a differential diagnosis.
• [9] mentions Brain Abscess as a condition that must be differentiated from epidural abscess.
• [10] describes Diskitis as an inflammation of the intervertebral discs.
• [11] lists Endocarditis as one of the conditions to consider in the differential diagnosis of epidural abscess.
• [5] and [9] also mention Fever of Unknown Origin (FUO) as a condition that can be confused with epidural abscess.
• [10] describes Herniated Nucleus Pulposus as a condition where the soft, gel-like center of the intervertebral disc bulges out.