Epidural abscess differential diagnosis: Difference between revisions
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===Intracranial Epidural Abscess=== | ===Intracranial Epidural Abscess=== | ||
An intracranial epidural abscess can replicate the [[signs]] and [[symptoms]] of any intracranial mass lesion. It may be presented by [[headache]], [[vomiting]], [[fever]], [[altered mental status]], [[seizures]], [[cranial nerve]] abnormalities and [[paresis]]. However, these signs may not be present initially, and may be shared by other conditions, which increases the complexity of the differential diagnosis. <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> Therefore, the differential diagnosis includes: | An intracranial epidural abscess can replicate the [[signs]] and [[symptoms]] of any intracranial mass lesion. It may be presented by [[headache]], [[vomiting]], [[fever]], [[altered mental status]], [[seizures]], [[cranial nerve]] abnormalities and [[paresis]]. However, these signs may not be present initially, and may be shared by other conditions, which increases the complexity of the differential diagnosis. <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> Therefore, the differential diagnosis includes: | ||
*Primary parenchymal tumor - | *Primary parenchymal [[tumor]] - | ||
*Metastatic tumor - | *[[Metastatic tumor]] - | ||
*Meningioma - | *[[Meningioma]] - | ||
*Hematoma - | *[[Hematoma]] - | ||
*Subdural empyema - | *[[Subdural empyema]] - | ||
*Brain abscess - | *[[Brain abscess]] - | ||
*Chronic meningitis - | *[[Meningitis|Chronic meningitis]] - | ||
*Tuberculous meningitis - | *[[Tuberculous meningitis]] - | ||
*Cranial arteritis - | *[[Cranial arteritis]] - | ||
===Spinal Epidural Abscess=== | ===Spinal Epidural Abscess=== | ||
At the time of presentation, the diagnosis of 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 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: | At the time of presentation, the diagnosis of 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 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: | ||
*Degenerative bone disease - | *[[Degenerative]] bone disease - | ||
*Intervertebral disc disease - | *[[Intervertebral disc]] disease - | ||
*Bone tuberculosis - | *Bone [[tuberculosis]] - | ||
*Primary or metastatic tumor - | *Primary or [[metastatic]] [[tumor]] - | ||
*Vertebral osteomyelitis - | *[[Vertebral osteomyelitis]] - | ||
*Sciatica secondary to disc herniation - | *[[Spinal disc herniation|Sciatica secondary to disc herniation]] - | ||
*Meningitis - | *[[Meningitis]] - | ||
*Herpes zoster - before appearance of skin lesions | *[[Herpes zoster]] - before appearance of skin lesions | ||
==References== | ==References== | ||
Revision as of 03:00, 21 March 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
An epidural abscess is a rare suppurative infection of the central nervous system, a collection of pus localised in the epidural space lying outside the dura mater, which accounts for less than 2% of focal CNS infections. [1] It may occur in two different places: intracranially or in the spinal canal. The diagnosis of epidural abscess, due to the unspecific clinical symptoms, is rarely a quick diagnosis. It is suspected based on clinical findings, along with laboratory data and imaging tests, however it can only be confirmed by surgical drainage. According to the location of the abscess, different conditions must be considered in the differential diagnosis.
Differential Diagnosis
Intracranial Epidural Abscess
An intracranial epidural abscess can replicate the signs and symptoms of any intracranial mass lesion. It may be presented by headache, vomiting, fever, altered mental status, seizures, cranial nerve abnormalities and paresis. However, these signs may not be present initially, and may be shared by other conditions, which increases the complexity of the differential diagnosis. [2] Therefore, the differential diagnosis includes:
- Primary parenchymal tumor -
- Metastatic tumor -
- Meningioma -
- Hematoma -
- Subdural empyema -
- Brain abscess -
- Chronic meningitis -
- Tuberculous meningitis -
- Cranial arteritis -
Spinal Epidural Abscess
At the time of presentation, the diagnosis of 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 epidural abscess usually presents with back pain, fever, motor weakness, and spinal tenderness. [3][4][5][6] Therefore, the differential diagnosis includes:
- Degenerative bone disease -
- Intervertebral disc disease -
- Bone tuberculosis -
- Primary or metastatic tumor -
- Vertebral osteomyelitis -
- Sciatica secondary to disc herniation -
- Meningitis -
- Herpes zoster - before appearance of skin lesions
References
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
- ↑ 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.