Epidural abscess (intracranial)

Background

• Much less common than spinal epidural abscess (1:9)
• Usually caused by local spread of infection or local 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

Diagnosis

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

DDX

• Any intracranial mass
  • ICH
  • Tumor
  • Brain abscess
  • Subdural empyema

Treatment

• Surgical decompresion
• Antibiotics
  • Vanco + metronidazole + either cefotaxime or ceftriaxone or ceftazadine
    • Ceftazidine is preferred if pseudomonas is considered likely
    • Can substitute nafcillin or oxacillin for vanco if not MRSA
  • Treat for 6-8 weeks
  • If likely nasopharyngeal source (sinusitis, mastoiditis), may consider regiment covering strep, hemophilus, and aerobes

See Also

Epidural Abscess (Spinal)

Sources

Uptodate