Epidural abscess (intracranial)

Background

Much less common than spinal epidural abscess (1:9)
Usually caused by local spread of infection or inoculation during surgery or trauma
Usually isolated to calvarium due to adherence of dura to foramen magnum

Clinical Features

Symptoms of intracranial mass

Differential Diagnosis

Intracranial Mass

Intracranial hemorrhage
- Intra-axial
  - Hemorrhagic stroke (Spontaneous intracerebral hemorrhage)
  - Traumatic intracerebral hemorrhage
- Extra-axial
  - Epidural hemorrhage
  - Subdural hemorrhage
  - Subarachnoid hemorrhage (aneurysmal intracranial hemorrhage)
Brain tumor
Brain abscess
Subdural empyema
Epidural abscess (intracranial)

Evaluation

Suspect diagnosis based on clinical history and physical exam
Imaging modality of choice is MRI
CT with IV contrast is reasonable alternative

Management

Surgical decompression
Antibiotics
- Vancomycin + metronidazole + (cefotaxime or ceftriaxone or ceftazidime)
  - Ceftazidime is preferred if pseudomonas is considered likely
  - Can substitute nafcillin or oxacillin for Vancomycin if not MRSA
- Treat for 6-8 weeks
- If likely nasopharyngeal source (sinusitis, mastoiditis), may consider regiment covering strep, Haemophilus influenzae, and aerobes

Disposition

Admit

See Also

References

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