Epidural abscess other diagnostic studies
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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. Because the initial symptoms and clinical characteristics are not always identical, and are similar to the ones in other diseases, along with the fact that they are both rare conditions, the final diagnosis might be delayed in time. This late diagnosis comes at great cost to the patient, since it is usually accompanied by a bad prognosis and severe complications with a potential fatal outcome. The diagnosis of epidural abscess should be first suspected from the clinical findings and posteriorly supported by laboratory tests and imaging studies, however it can only be confirmed after surgical drainage and proper study of the collected material. The laboratory test, despite helpful are not diagnostic and should always be used along history taking, clinical examination and imaging studies. According to the location of the collection, the abscess may have different origins, different organisms involved, symptoms, evolutions, complications and therapeutical techniques. [2][3]
Lumbar Puncture
CSF study is not a routine study, not only because it offers little information, but also because it has risks associated. About 3/4 of patients whose CSF is studied show:
- high protein level
- pleocytosis, with either polymorphonuclear or mononuclear predominance.
These findings, although suggestive of parameningeal infection, are not specific for the epidural infection. The gram-stain results of the CSF are usually negative, being positive only in about 19% of the cases. [3][4] The risks associated with the lumbar puncture include:
- inducing meningitis
- if the needle transverses the epidural abscess, it may cause a concomitant subdural infection
- inducing neurologic deterioration in case the LP is performed below a complete spinal subarachnoid block[3][4][5]
References
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
- ↑ Danner, R. L.; Hartman, B. J. (1987). "Update of Spinal Epidural Abscess: 35 Cases and Review of the Literature". Clinical Infectious Diseases. 9 (2): 265–274. doi:10.1093/clinids/9.2.265. ISSN 1058-4838.
- ↑ 3.0 3.1 3.2 Darouiche, Rabih O. (2006). "Spinal Epidural Abscess". New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 0028-4793.
- ↑ 4.0 4.1 Darouiche RO, Hamill RJ, Greenberg SB, Weathers SW, Musher DM (1992). "Bacterial spinal epidural abscess. Review of 43 cases and literature survey". Medicine (Baltimore). 71 (6): 369–85. PMID 1359381.
- ↑ Hlavin ML, Kaminski HJ, Ross JS, Ganz E (1990). "Spinal epidural abscess: a ten-year perspective". Neurosurgery. 27 (2): 177–84. PMID 2385333.