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.[1] Intracranial epidural abscess must be differentiated from:

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] 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 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

  1. 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.
  2. Grewal, S. (2006). "Epidural abscesses". British Journal of Anaesthesia. 96 (3): 292–302. doi:10.1093/bja/ael006. ISSN 0007-0912.
  3. 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.
  4. 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.
  5. Keon-Cohen BT (1968). "Epidural abscess simulating disc hernia". J Bone Joint Surg Br. 50 (1): 128–30. PMID 5641580.