Epidural abscess differential diagnosis: Difference between revisions

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Latest revision as of 21:36, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]; Anthony Gallo, B.S. [3]

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, weakness, and spinal tenderness, such as arthritis, osteoarthritis, intervertebral disc disease, vertebral osteomyelitis, primary or metastatic tumors, and musculoskeletal pain.

Differential Diagnosis

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.^[1] Intracranial epidural abscess must be differentiated from:


Disease	Findings
Hematoma	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.
Epidural hematoma	Presents with a collection of blood in the epidural space, headache, back pain, confusion, weakness, and focal neurologic signs
Subdural empyema	Presents with a collection of purulent material accumulating in the subdural space, mass effect, fever, headache, altered mental status, and seizures
Brain abscess	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
Chronic meningitis	Presents with inflammation of the meninges, headache, nuchal rigidity, fever, and altered mental status
Tuberculous meningitis	Presents with inflammation of the meninges, fever, headache, confusion, and focal neurologic signs
Tumor, including primary parenchymal, metastatic, and meningioma	Presents with an intracranial tumor, focal neurologic signs, increased intracranial pressure, and seizures
Temporal arteritis	Presents with inflammation of the blood vessels of the head, commonly the large and medium arteries, fever, headache, and focal neurologic signs

Spinal Epidural Abscess

Spinal epidural abscess must be differentiated from other diseases that cause back pain, fever, weakness, and spinal tenderness.^[2]^[3]^[4]^[5] Therefore, spinal epidural abscess must be differentiated from:


Disease	Findings
Musculoskeletal pain	Presents with lower back pain following overuse and over stretching of muscles, or in the context of a viral infection
Arthritis and Osteoarthritis	Presents with back pain, stiffness, tenderness, and weakness
Degenerative disc disease	Presents with lower back pain, tenderness, and weakness
Spinal disc herniation	Presents with the soft central nucleus pulposus bulging out, lower back pain, leg pain, tingling, numbness, and reflex changes
Shingles	Presents with painful skin rash, blisters, fever, headache, chills, and tingling sensations
Spinal cord ischemia	Presents with radiculopathy, weakness and pain
Vertebral osteomyelitis	Presents with infected bone and bone marrow, fever, back pain, swelling, weakness of the vertebral column and surrounding muscles, and night sweats
Leukemia	Presents with bruises, dyspnea, fever, chills, weakness, fatigue, headache, and bone and joint pain
Epidural hematoma	Presents with a collection of blood in the epidural space, headache, back pain, confusion, weakness, and focal neurologic signs
Chronic meningitis	Presents with inflammation of the meninges, headache, nuchal rigidity, fever, and altered mental status
Tumor	Presents with focal neurologic signs, increased intracranial pressure, lower back pain, and seizures

References

↑ Fountas KN, Duwayri Y, Kapsalaki E, Dimopoulos VG, Johnston KW, Peppard SB; et al. (2004). "Epidural intracranial abscess as a complication of frontal sinusitis: case report and review of the literature". South Med J. 97 (3): 279–82, quiz 283. PMID 15043336.
↑ Grewal, S. (2006). "Epidural abscesses". British Journal of Anaesthesia. 96 (3): 292–302. doi:10.1093/bja/ael006. ISSN 0007-0912.
↑ Maslen DR, Jones SR, Crislip MA, Bracis R, Dworkin RJ, Flemming JE (1993). "Spinal epidural abscess. Optimizing patient care". Arch Intern Med. 153 (14): 1713–21. PMID 8333809.
↑ Ngan Kee WD, Jones MR, Thomas P, Worth RJ (1992). "Extradural abscess complicating extradural anaesthesia for caesarean section". Br J Anaesth. 69 (6): 647–52. PMID 1467114.
↑ Keon-Cohen BT (1968). "Epidural abscess simulating disc hernia". J Bone Joint Surg Br. 50 (1): 128–30. PMID 5641580.

[pmid15043336-1] Fountas KN, Duwayri Y, Kapsalaki E, Dimopoulos VG, Johnston KW, Peppard SB; et al. (2004). "Epidural intracranial abscess as a complication of frontal sinusitis: case report and review of the literature". South Med J. 97 (3): 279–82, quiz 283. PMID 15043336.

[Grewal2006-2] Grewal, S. (2006). "Epidural abscesses". British Journal of Anaesthesia. 96 (3): 292–302. doi:10.1093/bja/ael006. ISSN 0007-0912.

[pmid8333809-3] Maslen DR, Jones SR, Crislip MA, Bracis R, Dworkin RJ, Flemming JE (1993). "Spinal epidural abscess. Optimizing patient care". Arch Intern Med. 153 (14): 1713–21. PMID 8333809.

[pmid1467114-4] Ngan Kee WD, Jones MR, Thomas P, Worth RJ (1992). "Extradural abscess complicating extradural anaesthesia for caesarean section". Br J Anaesth. 69 (6): 647–52. PMID 1467114.

[pmid5641580-5] Keon-Cohen BT (1968). "Epidural abscess simulating disc hernia". J Bone Joint Surg Br. 50 (1): 128–30. PMID 5641580.

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[2]

[3]

[4]

[5]

@@ Line 4: / Line 4: @@
 ==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 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]].
 ==Differential Diagnosis==
 ===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:
 {| style="border: 0px; font-size: 90%; margin: 3px;" align=center
@@ Line 16: / Line 16: @@
 |-
 | 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]].
 |-
 | 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]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Subdural empyema]]'''
-| 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]].
+| 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]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Brain abscess]] '''
-| 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]].
+| 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]]
 |-
 | 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]].
+| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[inflammation]] of the [[meninges]], [[headache]], [[nuchal rigidity]], [[fever]], and [[altered mental status]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Tuberculous meningitis]]'''
-| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[inflammation]] of the [[meninges]], [[fever]], [[headache]], [[confusion]], and [[focal neurologic signs]].
+| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[inflammation]] of the [[meninges]], [[fever]], [[headache]], [[confusion]], and [[focal neurologic signs]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Tumor]], including primary parenchymal, [[metastatic]], and [[meningioma]]'''
-| style="padding: 5px 5px; background: #F5F5F5;" | Presents with an [[intracranial tumor]], [[focal neurologic signs]], [[increased intracranial pressure]], and [[seizures]].
+| style="padding: 5px 5px; background: #F5F5F5;" | Presents with an [[intracranial tumor]], [[focal neurologic signs]], [[increased intracranial pressure]], and [[seizures]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Temporal arteritis]]'''
-| 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]].
+| 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]]
 |-
 |}
 ===Spinal Epidural Abscess===
-Spinal epidural abscess must be differentiated from other diseases that cause [[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, spinal epidural abscess must be differentiated from:
+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:
 {| style="border: 0px; font-size: 90%; margin: 3px;" align=center
@@ Line 50: / Line 50: @@
 |-
 | 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]].
+| 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]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" |'''[[Arthritis]] and [[Osteoarthritis]]'''
-| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[back pain]], [[stiffness]], [[tenderness]], and [[weakness]].
+| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[back pain]], [[stiffness]], [[tenderness]], and [[weakness]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Degenerative disc disease]] '''
-| style="padding: 5px 5px; background: #F5F5F5;" |Presents with [[lower back pain]], [[tenderness]], and [[weakness]].
+| style="padding: 5px 5px; background: #F5F5F5;" |Presents with [[lower back pain]], [[tenderness]], and [[weakness]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Spinal disc herniation]] '''
-| style="padding: 5px 5px; background: #F5F5F5;" | Presents with the soft central [[nucleus pulposus]] to bulging out, [[lower back pain]], [[leg pain]], [[tingling]], [[numbness]], and  [[reflex]] changes.
+| 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
 |-
 | 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.
+| style="padding: 5px 5px; background: #F5F5F5;" | Presents with painful [[skin rash]], [[blisters]], [[fever]], [[headache]], [[chills]], and [[tingling]] sensations
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Spinal cord]] [[ischemia]]'''
-| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[radiculopathy]], [[weakness]] and [[pain]].
+| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[radiculopathy]], [[weakness]] and [[pain]]
 |-
 | 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]].
+| 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]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Leukemia]]'''
-| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[bruises]], [[dyspnea]], [[fever]], [[chills]], [[weakness]], [[fatigue]], [[headache]], and [[bone pain|bone]] and [[joint pain]].
+| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[bruises]], [[dyspnea]], [[fever]], [[chills]], [[weakness]], [[fatigue]], [[headache]], and [[bone pain|bone]] and [[joint pain]]
 |-
 | 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]]
 |-
 | 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]].
+| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[inflammation]] of the [[meninges]], [[headache]], [[nuchal rigidity]], [[fever]], and [[altered mental status]]
 |-
 | 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]].
+| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[focal neurologic signs]], [[increased intracranial pressure]], [[lower back pain]], and [[seizures]]
 |-
 |}
@@ Line 87: / Line 87: @@
 {{Reflist|2}}
-[[Category:Infectious disease]]
 [[Category:Disease]]
 [[Category:Neurology]]
-[[Category:Primary care]]