Intracranial epidural abscess
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
- John H Sampson, MD, PhD, MBA
John H Sampson, MD, PhD, MBA
- Robert H. and Gloria Wilkins Distinguished Professor of Neurosurgery
- Professor of Biomedical Engineering, Immunology, and Pathology
- Chair, Department of Neurosurgery
- Duke University Medical Center
Epidural abscess is a rare but important suppurative infection of the central nervous system (CNS) . Abscesses that are enclosed within the bony confines of the skull or spinal column can expand to compress the brain or spinal cord and cause severe symptoms, permanent complications, or even death. Prompt diagnosis and proper treatment can avert complications and achieve cure in many cases. Both the diagnosis and management of epidural abscess, which often includes a surgical procedure for aspiration or drainage of the abscess, have been greatly aided by the advent of modern imaging techniques, such as computed tomography (CT) and especially magnetic resonance imaging (MRI) [2-4].
Two distinct varieties of epidural abscess occur: spinal epidural abscess (SEA) and intracranial epidural abscess (IEA). SEA is more common by a factor of nine to one. The distinction between these two entities is based upon the different anatomy of the two locations within the CNS and some differences in symptoms and natural history. Intracranial epidural abscesses (IEAs) are less common than spinal epidural abscess (SEAs) and less acute in their evolution. However, like SEAs, IEAs are significant infections requiring optimal therapy to prevent complications.
The epidemiology, microbiology, clinical manifestations, diagnosis, and treatment of IEA will be reviewed here. SEA, brain abscess, and bacterial meningitis are discussed separately. (See "Spinal epidural abscess" and "Pathogenesis, clinical manifestations, and diagnosis of brain abscess" and "Treatment and prognosis of bacterial brain abscess" and "Epidemiology of bacterial meningitis in adults" and "Pathogenesis and pathophysiology of bacterial meningitis" and "Clinical features and diagnosis of acute bacterial meningitis in adults" and "Initial therapy and prognosis of bacterial meningitis in adults" and "Treatment of bacterial meningitis caused by specific pathogens in adults" and "Neurologic complications of bacterial meningitis in adults".)
The intracranial dura mater forms the inner lining of the skull and is directly adherent to bone. Thus, under normal circumstances, there is no actual epidural space. The potential epidural space can be opened by pressure from expanding tumors, blood, inflammatory masses, or pus. This requires that the firmly adherent dura be dissected off the bone; as a result, intracranial epidural abscesses tend to be slow growing, rounded, and well localized.
PATHOGENESIS AND PATHOLOGY
Organisms usually spread into the potential extradural space by direct extension from a contiguous focus of infection or by inoculation during trauma or neurosurgery. Organisms may also pass through the venous foramina of the frontal bone plate to this space without causing frontal bone osteomyelitis. After reaching this site, the bacteria cause inflammation and the formation of pus or granulation tissue, which gradually dissect the tough and adherent dura away from the inner table of the skull.
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