Epidural abscess differential diagnosis

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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]; 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. 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. 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