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]
Disease
Findings
Hematoma 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 .
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]
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 to 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 .