Epidural abscess overview
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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. Due to the fact that the initial symptoms and clinical characteristics are not always identical and are similar to 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. According to the location of the collection, the abscess may have different origins, different organisms involved, symptoms, evolutions, complications and therapeutical techniques. [2] With the advent of antibiotics, along with accurate imaging studies and surgical techniques, prognosis and outcome of epidural abscess has greatly improved.
Pathophysiology
According to the location of the epidural abscess, its pathophysiology will differ, particularly in the origin of the infection but also in symptoms, commonly causing organism, progression of the condition and therefore the treatment required. In the case of intracranial epidural abscess, it surges most frequently as a complication of cranial surgical procedures or sinusitis, particularly paranasal sinusitis, as the infection progresses intracranially. [3] On the other hand, spinal epidual abscess happens most frequently due to spinal instrumentation, vascular access and injection drug use. [4]
Epidemiology and Demographics
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. [5] It may occur in two different places: intracranially or in the spinal canal. In both cases, in order to prevent severe morbidity and fatal outcomes, accurate diagnosis and prompt therapy should be applied as early as possible. According to the location of the infection, the epidemiology of each of the two types of abscess will differ, according to several factors.
Causes
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. It may occur in two different places: intracranially or in the spinal canal. According to the region of infection, some causing organisms will be shared by both types of abscess, however, others will be different, mainly because of the risk factors involved in that particular area and the mechanisms of infection. In the case of intracranial epidural abscess, the most common risk factors are sinusitis and neurosurgical procedures, while in the case of spinal epidural abscess, the most common risk factors are infections of the surrounding tissues and spinal procedures.
Diagnosis
Symptoms
Laboratory Findings
Treatment
Medical Therapy
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.
- ↑ 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.
- ↑ Strauss I, Carmi-Oren N, Hassner A, Shapiro M, Giladi M, Lidar Z (2013). "Spinal epidural abscess: in search of reasons for an increased incidence". Isr Med Assoc J. 15 (9): 493–6. PMID 24340840.
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.