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Epidural abscess

INTRODUCTION

Epidural abscess is a rare but important suppurative infection of the central nervous system (CNS). Enclosed within the rigid bony confines of the skull or spinal column, these focal lesions can expand to compress the brain or spinal cord, causing 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 this disorder, 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) [1-4].

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.

The epidemiology, microbiology, clinical manifestations, diagnosis, and treatment of epidural abscess will be reviewed here. Brain abscess and bacterial meningitis are discussed separately. (See "Pathogenesis, clinical manifestations, and diagnosis of brain abscess" and "Treatment and prognosis of brain abscess" and "Epidemiology of bacterial meningitis in adults" and "Pathogenesis of bacterial meningitis" and "Initial therapy and prognosis of bacterial meningitis in adults" and "Treatment of bacterial meningitis caused by specific pathogens in adults".)

SPINAL EPIDURAL ABSCESS

Spinal epidural abscess (SEA) is an important infection that requires prompt recognition and proper management to avoid potentially disastrous complications.

Anatomy — The anatomy of the spinal canal and dura mater determines many features of epidural abscesses [3]. Above the foramen magnum, the dura is adherent to the bone. Below the foramen magnum, an actual or true epidural space exists posterior and lateral to the spinal cord and extending down the length of the spinal canal (figure 1). This space is small in the cervical region and larger in the sacral region. The epidural space contains fat as well as arteries and a venous plexus. SEAs are more common in the thoracolumbar areas, where the epidural space is larger and contains more infection-prone fat tissue [1,5,6].
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References Top
  1. Danner, RL, Hartman, BJ. Update on spinal epidural abscess: 35 cases and review of the literature. Rev Infect Dis 1987; 9:265.
  2. Nussbaum, ES, Rigamonti, D, Standiford, H, et al. Spinal epidural abscess: A report of 40 cases and review. Surg Neurol 1992; 38:225.
  3. Gellin, BG, Weingarten, K, Gamache, FW Jr, et al. Epidural Abscess. In: Infections of the Central Nervous System, 2nd Ed, Scheld, WM, Whitley, RJ, Durack, DT (Eds), Lippincott-Raven Publishers, Philadelphia 1997, p. 507.
  4. Pradilla, G, Ardila, GP, Hsu, W, Rigamonti, D. Epidural abscesses of the CNS. Lancet Neurol 2009; 8:292.
  5. Darouiche, RO, Hamill, RJ, Greenberg, SB, et al. Bacterial spinal epidural abscess. Review of 43 cases and literature survey. Medicine (Baltimore) 1992; 71:369.
  6. Akalan, N, Ozgen, T. Infection as a cause of spinal cord compression: a review of 36 spinal epidural abscess cases. Acta Neurochir (Wien) 2000; 142:17.
  7. Kapeller, P, Fazekas, F, Krametter, D, et al. Pyogenic infectious spondylitis: Clinical, laboratory and MRI features. Eur Neurol 1997; 38:94.
  8. Torda, AJ, Gottlieb, T, Bradbury, R. Pyogenic vertebral osteomyelitis: Analysis of 20 cases and review. Clin Infect Dis 1995; 20:320.
  9. Sorensen, P. Spinal epidural abscesses: conservative treatment for selected subgroups of patients. Br J Neurosurg 2003; 17:513.
  10. Ptaszynski, AE, Hooten, WM, Huntoon, MA. The incidence of spontaneous epidural abscess in Olmsted County from 1990 through 2000: a rare cause of spinal pain. Pain Med 2007; 8:338.
  11. Wang, LP, Hauerberg, J, Schmidt, JF. Incidence of spinal epidural abscess after epidural analgesia: a national 1-year survey. Anesthesiology 1999; 91:1928.
  12. Phillips, JM, Stedeford, JC, Hartsilver, E, Roberts, C. Epidural abscess complicating insertion of epidural catheters. Br J Anaesth 2002; 89:778.
  13. Strong, WE. Epidural abscess associated with epidural catheterization: a rare event? Report of two cases with markedly delayed presentation. Anesthesiology 1991; 74:943.
  14. Gosavi, C, Bland, D, Poddar, R, Horst, C. Epidural abscess complicating insertion of epidural catheters. Br J Anaesth 2004; 92:294;.
  15. Scott, DB, Hibbard, BM. Serious non-fatal complications associated with extradural block in obstetric practice. Br J Anaesth 1990; 64:537.
  16. Gaul, C, Neundorfer, B, Winterholler, M. Iatrogenic (para-) spinal abscesses and meningitis following injection therapy for low back pain. Pain 2005; 116:407.
  17. Darouiche, RO. Spinal epidural abscess. N Engl J Med 2006; 355:2012.
  18. Sendi, P, Bregenzer, T, Zimmerli, W. Spinal epidural abscess in clinical practice. QJM 2008; 101:1.
  19. Rigamonti, D, Liem, L, Wolf, AL, et al. Epidural abscess in the cervical spine. Mt Sinai J Med 1994; 61:357.
  20. Griffiths, DL. Tuberculosis of the spine: A review. Adv Tuberc Res 1980; 20:92.
  21. Chen, WC, Wang, JL, Wang, JT, et al. Spinal epidural abscess due to Staphylococcus aureus: clinical manifestations and outcomes. J Microbiol Immunol Infect 2008; 41:215.
  22. Holt, HM, Andersen, SS, Andersen, O, et al. Infections following epidural catheterization. J Hosp Infect 1995; 30:253.
  23. Davis, DP, Wold, RM, Patel, RJ, et al. The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess. J Emerg Med 2004; 26:285.
  24. Mooney, RP, Hockberger, RS. Spinal epidural abscess: A rapidly progressive disease. Ann Emerg Med 1987; 16:1168.
  25. Liem, LK, Rigamonti, D, Wolf, AL, et al. Thoracic epidural abscess. J Spinal Disord 1994; 7:449.
  26. Curry, WT Jr, Hoh, BL, Amin-Hanjani, S, Eskander, EN. Spinal epidural abscess: clinical presentation, management, and outcome. Surg Neurol 2005; 63:364.
  27. Wong, D, Raymond, NJ. Spinal epidural abscess. N Z Med J 1998; 111:345.
  28. Moseley, IF, Kendall, BE. Radiology of intracranial empyemas, with special reference to computed tomography. Neuroradiology 1984; 26:333.
  29. Wheeler, D, Keiser, P, Rigamonti, D, et al. Medical management of spinal epidural abscesses: Case report and review. Clin Infect Dis 1992; 15:22.
  30. Siddiq, F, Chowfin, A, Tight, R, et al. Medical vs surgical management of spinal epidural abscess. Arch Intern Med 2004; 164:2409.
  31. Khanna, RK, Malik, GM, Rock, JP, Rosenblum, ML. Spinal epidural abscess: evaluation of factors influencing outcome. Neurosurgery 1996; 39:958.
  32. Baker, AS, Ojemann, RG, Swartz, MN, Richardson, EP Jr. Spinal epidural abscess. N Engl J Med 1975; 293:463.
  33. Koo, DW, Townson, AF, Dvorak, MF, Fisher, CG. Spinal epidural abscess: a 5-year case-controlled review of neurologic outcomes after rehabilitation. Arch Phys Med Rehabil 2009; 90:512.
  34. Heran, NS, Steinbok, P, Cochrane, DD. Conservative neurosurgical management of intracranial epidural abscesses in children. Neurosurgery 2003; 53:893.
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