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
  • papilledema
  • focal neurologic symptoms
  • Headache
  • Vomiting/nausea

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 decompresion
• 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

• Epidural abscess (spinal)

References

Authors

Daniel Poon, Ross Donaldson, Michael Holtz, Daniel Ostermayer, Neil Young, Jordan Swartz