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 inoculation during surgery or trauma | *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]] | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==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 with IV contrast is reasonable alternative | *[[head CT|CT]] with IV contrast is reasonable alternative | ||
==Management== | ==Management== | ||
*Surgical | *Surgical decompression | ||
*Antibiotics | *Antibiotics | ||
**[[Vancomycin]] + [[metronidazole]] + ([[cefotaxime]] '''or''' [[ceftriaxone]] '''or''' [[ceftazidime]]) | **[[Vancomycin]] + [[metronidazole]] + ([[cefotaxime]] '''or''' [[ceftriaxone]] '''or''' [[ceftazidime]]) | ||
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==See Also== | ==See Also== | ||
*[[Epidural abscess (spinal)]] | *[[Epidural abscess (spinal)]] | ||
*[[Brain abscess]] | |||
==References== | ==References== | ||
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