Epidural Abscess (intracranial or spinal)

Diagnosis:

Imaging (MRI with and without contrast) plus biopsy for confirmation

Pathology:

Biopsy:

  • Necrosis with inflammation (neutrophils & later macrophages & lymphocytes), rim of fibrosis (if absent this is cerebritis)
  • Surrounding gliosis

Clinical features:

  • Intracranial: focal neurological deficit
  • Spinal: transverse myelopathy and a flexed posture resisting extension, back pain with fever.

Investigations to consider:

FBC, ESR, CRP
Blood cultures
LP for CSF:

  • Pleocytosis & increased protein
  • NB. Not at the site of abscess
  • Gram stain & culture of excised material

MRI, gadolinium enhanced
Consider myelography

Treatment:

Neurological emergency
Surgery, not done in some cases in absence of compression
Antibiotics:

  • Naficillin or vancomycin intravenous empirically
  • Same doses as meningitis

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