Epidural abscess (intracranial): Difference between revisions
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== Background == | ==Background== | ||
*Much less common than spinal epidural abscess (1:9) | *Much less common than [[spinal epidural abscess]] (1:9) | ||
*Usually caused by local spread of infection or | *Usually caused by local spread of infection or inoculation during surgery or [[head trauma|trauma]] | ||
*Usually isolated to calvarium due to adherence of dura to foramen magnum | *Usually isolated to calvarium due to adherence of dura to foramen magnum | ||
== Clinical Features == | ==Clinical Features== | ||
*Symptoms of intracranial mass | *Symptoms of [[intracranial mass]] | ||
**papilledema | **[[papilledema]] | ||
**focal neurologic symptoms | **[[focal neuro deficits|focal neurologic symptoms]] | ||
** | **[[headache]] | ||
** | **[[nausea/vomiting]] | ||
== Diagnosis == | ==Differential Diagnosis== | ||
{{Intracranial mass DDX}} | |||
==Evaluation== | |||
*Suspect diagnosis based on clinical history and physical exam | *Suspect diagnosis based on clinical history and physical exam | ||
*Imaging modality of choice is MRI | *Imaging modality of choice is [[brain MRI|MRI]] | ||
*CT | *[[head CT|CT]] with IV contrast is reasonable alternative | ||
== | ==Management== | ||
*Surgical decompression | |||
*Surgical | |||
*Antibiotics | *Antibiotics | ||
** | **[[Vancomycin]] + [[metronidazole]] + ([[cefotaxime]] '''or''' [[ceftriaxone]] '''or''' [[ceftazidime]]) | ||
*** | ***[[Ceftazidime]] is preferred if [[pseudomonas]] is considered likely | ||
***Can substitute nafcillin or oxacillin for | ***Can substitute [[nafcillin]] or [[oxacillin]] for [[Vancomycin]] if not [[MRSA]] | ||
**Treat for 6-8 weeks | **Treat for 6-8 weeks | ||
**If likely nasopharyngeal source (sinusitis, mastoiditis), may consider regiment covering strep, | **If likely nasopharyngeal source ([[sinusitis]], [[mastoiditis]]), may consider regiment covering [[strep]], [[Haemophilus influenzae]], and [[aerobes]] | ||
==Disposition== | |||
*Admit | |||
==See Also== | ==See Also== | ||
[[Epidural | *[[Epidural abscess (spinal)]] | ||
*[[Brain abscess]] | |||
== | ==References== | ||
<References/> | |||
[[Category: | [[Category:Neurology]] | ||
[[Category:ID]] | [[Category:ID]] | ||
Latest revision as of 00:31, 2 October 2019
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
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)
- Intra-axial
- 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
- Vancomycin + metronidazole + (cefotaxime or ceftriaxone or ceftazidime)
Disposition
- Admit