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| ==Overview== | | ==Overview== |
| Intracranial epidural abscess must be differentiated from [[epidural hematoma]], [[subdural empyema]], [[brain abscess]], [[tuberculous meningitis]], and other intracranial mass lesions. Spinal epidural abscess must be differentiated from other conditions that cause [[back pain]], motor weakness, and/or spinal tenderness, such as [[arthritis]], [[osteoarthritis]], [[intervertebral disc]] disease, [[vertebral osteomyelitis]], [[primary tumor|primary]] or [[metastatic tumor]]s, and [[musculoskeletal pain]]. | | Intracranial epidural abscess must be differentiated from [[epidural hematoma]], [[subdural empyema]], [[brain abscess]], [[tuberculous meningitis]], and other intracranial mass lesions. Spinal epidural abscess must be differentiated from other conditions that cause [[back pain]], [[weakness]], and spinal [[tenderness]], such as [[arthritis]], [[osteoarthritis]], [[intervertebral disc]] disease, [[vertebral osteomyelitis]], [[primary tumor|primary]] or [[metastatic tumor]]s, and [[musculoskeletal pain]]. |
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| ==Differential Diagnosis== | | ==Differential Diagnosis== |
| ===Intracranial Epidural Abscess=== | | ===Intracranial Epidural Abscess=== |
| Intracranial epidural abscess must be differentiated from other diseases that cause [[headache]], [[vomiting]], [[fever]], [[altered mental status]], [[seizures]], [[cranial nerve]] abnormalities, and [[paresis]].<ref name="pmid15043336">{{cite journal| author=Fountas KN, Duwayri Y, Kapsalaki E, Dimopoulos VG, Johnston KW, Peppard SB et al.| title=Epidural intracranial abscess as a complication of frontal sinusitis: case report and review of the literature. | journal=South Med J | year= 2004 | volume= 97 | issue= 3 | pages= 279-82; quiz 283 | pmid=15043336 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15043336 }} </ref> Intracranial epidural abscess must be differentiated from: | | Intracranial epidural abscess must be differentiated from other diseases that cause [[headache]], [[vomiting]], [[fever]], [[altered mental status]], [[seizures]], [[cranial nerve]] abnormalities, and [[paresis]].<ref name="pmid15043336">{{cite journal| author=Fountas KN, Duwayri Y, Kapsalaki E, Dimopoulos VG, Johnston KW, Peppard SB et al.| title=Epidural intracranial abscess as a complication of frontal sinusitis: case report and review of the literature. | journal=South Med J | year= 2004 | volume= 97 | issue= 3 | pages= 279-82; quiz 283 | pmid=15043336 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15043336 }} </ref> Intracranial epidural abscess must be differentiated from: |
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Hematoma]]''' | | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Hematoma]]''' |
| | style="padding: 5px 5px; background: #F5F5F5;" | Presents with a collection of [[blood]], [[bruise]] (if it occurs near the [[skin]]). If it occurs near the [[brain]], it may act as a [[mass effect]], and the patient may present with [[increased intracranial pressure]], midline shift, and [[brain herniation]]. | | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with a collection of [[blood]] or [[bruise]] (if it occurs near the [[skin]]). If it occurs near the [[brain]], it may act as a [[mass effect]], and the patient may present with [[increased intracranial pressure]], midline shift, and [[brain herniation]]. |
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| | style="padding: 5px 5px; background: #DCDCDC;" |'''[[Epidural hematoma]]''' | | | style="padding: 5px 5px; background: #DCDCDC;" |'''[[Epidural hematoma]]''' |
| | style="padding: 5px 5px; background: #F5F5F5;" |Presents with a collection of [[blood]] in the [[epidural space]], [[headache]], [[back pain]], [[confusion]], [[weakness]], and [[focal neurologic signs]]. | | | style="padding: 5px 5px; background: #F5F5F5;" |Presents with a collection of [[blood]] in the [[epidural space]], [[headache]], [[back pain]], [[confusion]], [[weakness]], and [[focal neurologic signs]] |
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Lassa fever]]''' | | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Subdural empyema]]''' |
| | style="padding: 5px 5px; background: #F5F5F5;" |Disease onset is usually gradual, with [[fever]], [[sore throat]], [[cough]], [[pharyngitis]], and [[facial edema]] in the later stages. [[Inflammation]] and exudation of the [[pharynx]] and [[conjunctiva]] are common. | | | style="padding: 5px 5px; background: #F5F5F5;" |Presents with a collection of [[purulent]] material accumulating in the [[subdural space]], [[mass effect]], [[fever]], [[headache]], [[altered mental status]], and [[seizures]] |
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Yellow fever]] and other [[Flaviviridae]] ''' | | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Brain abscess]] ''' |
| | style="padding: 5px 5px; background: #F5F5F5;" | Present with [[hemorrhage|hemorrhagic]] complications. [[Epidemiological]] investigation may reveal a pattern of disease [[transmission]] by an insect vector. Virus isolation and serological investigation serves to distinguish these [[viruses]]. Confirmed history of previous [[yellow fever]] [[vaccination]] will rule out [[yellow fever]]. | | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with a collection of [[purulent]] material within the [[brain]] tissue, [[confusion]], decreased movement, decreased sensation, decreasing responsiveness, [[drowsiness]], [[fever]], [[headache]], [[loss of coordination]], [[nausea]], [[seizure]], and [[vomiting]] |
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Shigellosis]] & other bacterial enteric infections''' | | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Meningitis|Chronic meningitis]]''' |
| | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[diarrhea]], possibly [[Dysentery|bloody]], accompanied by [[fever]], [[nausea]], and [[toxemia]], [[vomiting]], [[cramps]], and [[tenesmus]]. [[Stool]]s contain [[blood]] and mucous in a typical case. A search for possible sites of bacterial infection, together with cultures and [[blood smear]]s, should be made. Presence of [[leucocytosis]] distinguishes bacterial infections from [[viral infections]]. | | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[inflammation]] of the [[meninges]], [[headache]], [[nuchal rigidity]], [[fever]], and [[altered mental status]] |
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Ebola]]''' | | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Tuberculous meningitis]]''' |
| | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[fever]], [[chills]] [[vomiting]], [[diarrhea]], generalized [[pain]] or [[malaise]], and [[Internal bleeding|internal]] and external [[bleeding]], that follow an [[incubation period]] of 2-21 days. | | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[inflammation]] of the [[meninges]], [[fever]], [[headache]], [[confusion]], and [[focal neurologic signs]] |
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Lassa fever]]''' | | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Tumor]], including primary parenchymal, [[metastatic]], and [[meningioma]]''' |
| | style="padding: 5px 5px; background: #F5F5F5;" |Disease onset is usually gradual, with [[fever]], [[sore throat]], [[cough]], [[pharyngitis]], and [[facial edema]] in the later stages. [[Inflammation]] and exudation of the [[pharynx]] and [[conjunctiva]] are common. | | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with an [[intracranial tumor]], [[focal neurologic signs]], [[increased intracranial pressure]], and [[seizures]] |
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Yellow fever]] and other [[Flaviviridae]] ''' | | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Temporal arteritis]]''' |
| | style="padding: 5px 5px; background: #F5F5F5;" | Present with [[hemorrhage|hemorrhagic]] complications. [[Epidemiological]] investigation may reveal a pattern of disease [[transmission]] by an insect vector. Virus isolation and serological investigation serves to distinguish these [[viruses]]. Confirmed history of previous [[yellow fever]] [[vaccination]] will rule out [[yellow fever]]. | | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[inflammation]] of the [[blood vessels]] of the [[head]], commonly the large and medium [[arteries]], [[fever]], [[headache]], and [[focal neurologic signs]] |
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Shigellosis]] & other bacterial enteric infections''' | | |} |
| | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[diarrhea]], possibly [[Dysentery|bloody]], accompanied by [[fever]], [[nausea]], and [[toxemia]], [[vomiting]], [[cramps]], and [[tenesmus]]. [[Stool]]s contain [[blood]] and mucous in a typical case. A search for possible sites of bacterial infection, together with cultures and [[blood smear]]s, should be made. Presence of [[leucocytosis]] distinguishes bacterial infections from [[viral infections]]. | | |
| | ===Spinal Epidural Abscess=== |
| | Spinal epidural abscess must be differentiated from other diseases that cause [[back pain]], [[fever]], [[weakness]], and spinal [[tenderness]].<ref name="Grewal2006">{{cite journal|last1=Grewal|first1=S.|title=Epidural abscesses|journal=British Journal of Anaesthesia|volume=96|issue=3|year=2006|pages=292–302|issn=0007-0912|doi=10.1093/bja/ael006}}</ref><ref name="pmid8333809">{{cite journal| author=Maslen DR, Jones SR, Crislip MA, Bracis R, Dworkin RJ, Flemming JE| title=Spinal epidural abscess. Optimizing patient care. | journal=Arch Intern Med | year= 1993 | volume= 153 | issue= 14 | pages= 1713-21 | pmid=8333809 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8333809 }} </ref><ref name="pmid1467114">{{cite journal| author=Ngan Kee WD, Jones MR, Thomas P, Worth RJ| title=Extradural abscess complicating extradural anaesthesia for caesarean section. | journal=Br J Anaesth | year= 1992 | volume= 69 | issue= 6 | pages= 647-52 | pmid=1467114 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1467114 }} </ref><ref name="pmid5641580">{{cite journal| author=Keon-Cohen BT| title=Epidural abscess simulating disc hernia. | journal=J Bone Joint Surg Br | year= 1968 | volume= 50 | issue= 1 | pages= 128-30 | pmid=5641580 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5641580 }} </ref> Therefore, spinal epidural abscess must be differentiated from: |
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| | ! style="background: #4479BA; width: 120px;" | {{fontcolor|#FFF|Disease}} |
| | ! style="background: #4479BA; width: 550px;" | {{fontcolor|#FFF|Findings}} |
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| | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Musculoskeletal pain]]''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[lower back pain]] following overuse and over stretching of [[muscles]], or in the context of a [[viral infection]] |
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| | | style="padding: 5px 5px; background: #DCDCDC;" |'''[[Arthritis]] and [[Osteoarthritis]]''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[back pain]], [[stiffness]], [[tenderness]], and [[weakness]] |
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| | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Degenerative disc disease]] ''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" |Presents with [[lower back pain]], [[tenderness]], and [[weakness]] |
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| | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Spinal disc herniation]] ''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with the soft central [[nucleus pulposus]] bulging out, [[lower back pain]], [[leg pain]], [[tingling]], [[numbness]], and [[reflex]] changes |
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| | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Shingles]]''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with painful [[skin rash]], [[blisters]], [[fever]], [[headache]], [[chills]], and [[tingling]] sensations |
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| | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Spinal cord]] [[ischemia]]''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[radiculopathy]], [[weakness]] and [[pain]] |
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| | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Vertebral osteomyelitis]]''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with infected [[bone]] and [[bone marrow]], [[fever]], [[back pain]], [[swelling]], [[weakness]] of the [[vertebral column]] and surrounding [[muscles]], and [[night sweats]] |
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Ebola]]''' | | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Leukemia]]''' |
| | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[fever]], [[chills]] [[vomiting]], [[diarrhea]], generalized [[pain]] or [[malaise]], and [[Internal bleeding|internal]] and external [[bleeding]], that follow an [[incubation period]] of 2-21 days. | | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[bruises]], [[dyspnea]], [[fever]], [[chills]], [[weakness]], [[fatigue]], [[headache]], and [[bone pain|bone]] and [[joint pain]] |
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| | style="padding: 5px 5px; background: #DCDCDC;" | '''Others''' | | | style="padding: 5px 5px; background: #DCDCDC;" |'''[[Epidural hematoma]]''' |
| | style="padding: 5px 5px; background: #F5F5F5;" |[[Scarlet fever]], [[leptospirosis]], [[viral hepatitis]], [[typhus]], and [[mononucleosis]] can produce [[signs]] and [[symptoms]] that may be confused with rheumatic fever in early stages of infection. | | | style="padding: 5px 5px; background: #F5F5F5;" |Presents with a collection of [[blood]] in the [[epidural space]], [[headache]], [[back pain]], [[confusion]], [[weakness]], and [[focal neurologic signs]] |
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| | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Meningitis|Chronic meningitis]]''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[inflammation]] of the [[meninges]], [[headache]], [[nuchal rigidity]], [[fever]], and [[altered mental status]] |
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| | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Tumor]]''' |
| | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[focal neurologic signs]], [[increased intracranial pressure]], [[lower back pain]], and [[seizures]] |
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| *'''[[]]''' -
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| *'''[[]]''' -
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| *'''[[Subdural empyema]]''' - consists of a collection of [[purulent]] material, accumulating in the [[subdural space]]. Once it exerts a [[mass effect]], it may compress other [[brain]] structures, causing various [[signs]] and [[symptoms]]. Since it also represents an [[inflammatory]] component, the [[inflammation]] might spread to other [[brain]] structures, affecting their normal functioning. The [[signs]] and [[symptoms]] may include: [[fever]], [[headache]], [[altered mental status]] and [[seizures]]. As these [[symptoms]] are shared by [[epidural abscess]], it should be part of the differential diagnosis.
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| *'''[[Brain abscess]]''' - consists of a collection of [[purulent]] material within the [[brain]] tissue. The [[infection]] may originate in a nearby tissue, such as [[paranasal sinuses]], remote tissue, such as [[lung]] or [[kidney]], or be introduced during [[neurosurgery]] or head [[trauma]]. Either the [[infection]] of the [[brain]] tissue, or the [[mass effect]] caused by it, may cause [[signs]] and [[symptoms]], similar to the ones of epidural abscess.
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| *'''Primary parenchymal [[tumor]]''' - consists in any [[intracranial tumor]] located, and with its origin, in the [[brain]] parenchyma. Although they can be located anywhere in the [[brain]] parenchyma, in [[children]] they are commonly located in the [[posterior cranial fossa]], while in [[adult]]s, they can affect any part of the [[brain]]. Because of the different locations [[brain]] parenchymal [[tumors]] may take, there may also be many different [[signs]] and [[symptoms]]. These include: [[focal neurologic signs]], increasing [[intracranial pressure]] and [[seizures]].
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| *'''[[Metastatic tumor]]''' - consists in any [[intracranial tumor]], which has spread from another organ or [[tissue]], making the [[brain tumor]], a secondary [[tumor]]. Depending on the location of the [[brain]] affected, there will be different [[signs]] and [[symptoms]]. These may include: [[focal neurologic signs]], increasing [[intracranial pressure]], [[seizures]] and others, which may mimic [[signs]] and [[symptoms]] from epidural abscess.
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| *'''[[Meningioma]]''' - consists in a [[tumor]] arising from the arachnoidal cap cells of the [[meninges]]. In 95% of the cases it's a [[benign tumor]]. Depending on the size and location of the [[tumor]], different areas of the [[brain]] may be affected, therefore it may manifest itself with different [[signs]] and [[symptoms]], including [[focal neurologic signs]], increasing [[intracranial pressure]] and [[seizures]]. Since these are shared with [[epidural abscess]], this condition should be in the differential diagnosis.
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| *'''[[Meningitis|Chronic meningitis]]''' - consists in the [[inflammation]] of the [[meninges]], as a response to [[infectious agents]], certain [[drugs]], [[trauma]] or [[cancer]]. The [[inflammatory]] process will cause [[signs]] and [[symptoms]] such as [[headache]], [[nuchal rigidity]], [[fever]] and [[altered mental status]], which are similar to those of [[epidural abscess]] and why it should be in the differential diagnosis.
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| *'''[[Tuberculous meningitis]]''' - consists in the [[inflammation]] of the [[meninges]], caused by the organism ''[[Mycobacterium tuberculosis]]''. [[Fever]] and [[headache]] are the cardinal [[symptoms]] however, other [[symptoms]] such as [[confusion]] and [[focal neurologic signs]] may also be present, making [[tuberculous meningitis]] an important element of the differential diagnosis.
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| *'''[[Cranial arteritis]]''' - or [[temporal arteritis]] is an [[inflammation]] of the [[blood vessels]] of the [[head]], commonly the large and medium [[arteries]]. Among others, it may manifest with [[fever]], [[headache]] and [[focal neurologic signs]], making it an important element of this differential diagnosis
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| ===Spinal Epidural Abscess===
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| At the time of presentation, the diagnosis of [[spinal cord|spinal]] [[epidural abscess]] is only suspected in 40% of the cases. This is due to the fact that there are several other conditions, more common than this type of [[abscess]], presenting with similar [[signs]] and [[symptoms]]. [[Spinal cord|Spinal]] [[epidural abscess]] usually presents with [[back pain]], [[fever]], motor [[weakness]], and spinal [[tenderness]]. <ref name="Grewal2006">{{cite journal|last1=Grewal|first1=S.|title=Epidural abscesses|journal=British Journal of Anaesthesia|volume=96|issue=3|year=2006|pages=292–302|issn=0007-0912|doi=10.1093/bja/ael006}}</ref><ref name="pmid8333809">{{cite journal| author=Maslen DR, Jones SR, Crislip MA, Bracis R, Dworkin RJ, Flemming JE| title=Spinal epidural abscess. Optimizing patient care. | journal=Arch Intern Med | year= 1993 | volume= 153 | issue= 14 | pages= 1713-21 | pmid=8333809 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8333809 }} </ref><ref name="pmid1467114">{{cite journal| author=Ngan Kee WD, Jones MR, Thomas P, Worth RJ| title=Extradural abscess complicating extradural anaesthesia for caesarean section. | journal=Br J Anaesth | year= 1992 | volume= 69 | issue= 6 | pages= 647-52 | pmid=1467114 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1467114 }} </ref><ref name="pmid5641580">{{cite journal| author=Keon-Cohen BT| title=Epidural abscess simulating disc hernia. | journal=J Bone Joint Surg Br | year= 1968 | volume= 50 | issue= 1 | pages= 128-30 | pmid=5641580 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=5641580 }} </ref> Therefore, the differential diagnosis includes:
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| *'''[[Musculoskeletal pain]]''' - can be related to several other diseases, however it can be an entity in itself, following overuse and over stretching of [[muscles]], or in the context of a [[viral infection]]. When located in the [[lower back]], it may be included in the differential diagnosis of [[epidural abscess]], since this is one of the possible [[symptoms]] of this condition.
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| *'''[[Arthritis]]''' - despite the many types of [[arthritis]], [[osteoarthritis]], also known as degenerative [[joint]] disease, is the most common form and may result from [[trauma]], [[infection]] or be a result of aging. It may be responsible for [[back pain]] or [[stiffness]] which, since are also possible presentations of [[epidural abscess]], justify the inclusion of this condition in the differential diagnosis.
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| *'''[[Degenerative]] bone disease''' - may include several conditions of the [[bone]]. The common ground is the weakening of the [[bone]] structure, such as in [[osteoporosis]] which, among others, may cause lower [[back pain]] or [[tenderness]] and [[weakness]]. Since these [[symptoms]] may be present in [[epidural abscess]] as well, this condition should be part of the differential diagnosis.
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| *'''[[Intervertebral disc]] disease''' - [[degenerative disc disease]] is a common disorder of the lower [[spinal cord|spine]], in which disc degeneration may lead to [[spinal stenosis]], [[spondylolisthesis]] and [[osteoarthritis]]. These conditions may be manifested by lower [[back pain]], [[weakness]] and [[tenderness]], which explain why this condition should be included in the differential diagnosis.
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| *'''[[Spinal disc herniation|Sciatica secondary to disc herniation]]''' - consists in a condition affecting the [[spine]], in which a tear in the outer [[Annulus fibrosus disci intervertebralis|annulus fibrosus]] of an [[intervertebral disc]] allows the soft central [[nucleus pulposus]] to bulge out. This tear may cause an [[inflammatory]] reaction, which will cause severe [[pain]], even in the absence of [[spinal cord|spinal]] compression. It may be manifested by: lower [[back pain|back]] and [[leg pain]], [[sensory]] changes, such as [[tingling]], [[numbness]], and [[reflex]] changes. Since some of these [[signs]] and [[symptoms]] are shared with [[epidural abscess]], it should be part of the differential diagnosis.
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| *'''[[Epidural hematoma]]''' - consists in the buildup of [[blood]] in the [[epidural space]], between the [[dura mater]] and the inner [[bone]] surface of the [[skull]] or [[spinal canal]]. It may cause [[headache]] or [[back pain]], depending on the location of the [[hematoma]], [[confusion]], [[weakness]], [[focal neurologic signs]] and others. Since many of this [[signs]] and [[symptoms]] are shared with the [[epidural abscess]], this conditions should be included in the differential diagnosis.
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| *'''[[Meningitis]]''' - consists in the [[inflammation]] of the [[meninges]], as a response to [[infectious agents]], certain [[drugs]], [[trauma]] or [[cancer]]. The [[inflammatory]] process will cause [[signs]] and [[symptoms]] such as [[headache]], [[back pain]], [[nuchal rigidity]], [[fever]] and [[altered mental status]], which are similar to those of [[epidural abscess]], and why [[meningitis]] should be on the differential diagnosis.
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| *'''[[Bone]] [[tuberculosis]]''' - a presentation of extrapulmonary [[tuberculosis]], affecting the [[bones]], most often the [[spine]] ([[Pott's disease]], at the level of lower thoracic and upper lobar [[vertebrae]]. It results from an hematogenous spread of the organism from other sites, commonly the [[lung]]. It may have various [[signs]] and [[symptoms]], from which back [[pain]], [[fever]] and [[weakness]] are common to the [[epidural abscess]], making this an important element of the differential diagnosis.{{Seealso|Pott's disease}}
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| *'''[[Vertebral osteomyelitis]]''' - consists in an [[infection]] of the [[bone]] and [[bone marrow]], concentrated in the [[spinal cord|spinal]] region. It may affect two [[vertebrae]] and the [[intervertebral disc|disc]] in between and therefore be responsible for the narrowing of the space between the two. The disease may be [[acute]] or [[chronic]], however it is more commonly known to be an [[acute]] condition. It may manifest with: [[fever]], [[back pain]], [[swelling]], [[weakness]] of the [[vertebral column]] and surrounding [[muscles]] and [[night sweats]]. Since some of the [[symptoms]] are shared with epidural abscess, this conditions should be in the differential diagnosis.
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| *'''Primary or [[metastatic]] [[tumor]]''' - consists in any [[tumor]] arising from the [[spinal cord]], or elsewhere in the body, which metastasises to the [[spinal cord]]. Depending on its location, it may be classified as: ''extradural'', ''intramural'' or ''intramedullary'' [[spinal tumor]]. It will create a [[mass effect]], which will compress the [[spinal cord]] and weaken the [[vertebral]] structure, causing [[signs]] and [[symptoms]], such as: [[incontinence]], [[weakness]] in the saddle area and [[back pain]]. Therefore it should also be included in this differential diagnosis.
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| *'''[[Leukemia]]''' - [[cancer]] of the [[blood]] or [[bone marrow]], characterized by an abnormal proliferation of [[blood cells]], usually [[leukocytes]]. Among other [[signs]] and [[symptoms]], it may present with [[bruises]], [[dyspnea]], [[fever]], [[chills]], [[weakness]] and [[fatigue]], [[headache]] and other neurologic symptoms, [[bone pain|bone]] and [[joint pain]]. Since some of these are common with [[epidural abscess]], this condition should be included in the differential diagnosis.
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| *'''[[Herpes zoster]]''' - (before appearance of [[skin]] lesions) commonly known as [[shingles]], consists of a [[viral disease]], characterized by a painful [[skin rash]] with [[blisters]] on a limited area, usually unilateral, often in a stripe pattern. [[Signs]] and [[symptoms]] may include [[fever]], [[headache]], [[chills]] and [[tingling]] sensations. Since some of these are shared with [[epidural abscess]], this condition should be in the differential diagnosis.
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| *'''[[Spinal cord]] [[ischemia]]''' - consists in the deprivation of [[blood]] of a part of the [[spinal cord]]. It may arise in numerous settings, namely [[thrombosis|thrombotic events]], following [[trauma]], compression of the [[arteries]] from a [[mass effect|mass]], which can be from an [[hematoma]], [[abscess]], [[tumor]] or [[bone]] structure. This deprivation can cause different [[signs]] and [[symptoms]], depending on the area of the [[spinal cord]] affected, such as: [[radiculopathy]], [[weakness]] and [[pain]]. Since these are shared with [[epidural abscess]], this condition should be included in the differential diagnosis.
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| ==References== | | ==References== |
| {{Reflist|2}} | | {{Reflist|2}} |
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| [[Category:Wikinfect]]
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| [[Category:Infectious disease]]
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| [[Category:Disease]] | | [[Category:Disease]] |
| [[Category:Neurology]] | | [[Category:Neurology]] |
| [[Category:Primary care]]
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