What are the other Names for this Condition? (Also known as/Synonyms)

• Spinal Abscess

What is Epidural Abscess? (Definition/Background Information)

• Epidural abscess is a rare, potentially life-threatening disorder characterized by the accumulation of pus between the meninges (outer covering of the brain and spinal cord) and the bones of the skull or spine, resulting in swelling of the affected area
• There are various types of Epidural Abscess which include:
  • Intracranial Epidural Abscess (inside the skull)
  • Spinal Epidural Abscess (around the spinal cord)
• The most common cause of Epidural Abscess is infection by Staphylococcus aureus bacteria
• Diagnosis of the condition is made by physical exam, the culture of the abscess, CT scan of the head and affected regions, and an MRI scan of the brain and spinal cord
• An early diagnosis and appropriate treatment will result in good prognosis in a majority of the individuals diagnosed with Epidural Abscess
• Intravenous antibiotics are the mainstay of treatment. However, if symptoms like weakness, paralysis, and loss of sensations occur, the prognosis is guarded

Who gets Epidural Abscess? (Age and Sex Distribution)

• Epidural Abscess can occur at any age
• Spinal Epidural Abscess most commonly occurs in between the ages of 50-60 years
• Intracranial Epidural Abscess generally affects individuals between the ages of 20-30 years
• The condition affects both males and females
• It is observed worldwide; all racial and ethnic groups may be affected 

What are the Risk Factors for Epidural Abscess? (Predisposing Factors)

The risk factors for Epidural Abscess depend upon whether it is an Intracranial Epidural Abscess or Spinal Epidural Abscess.

The risk factors for Intracranial Epidural Abscess include:

• Chronic ear infection
• Chronic sinusitis
• Injury  to the head
• Mastoiditis: Infection that occurs in the air cells of the skull behind the ear
• Neurosurgery (brain surgery)
• Boils on the scalp

The risk factors for Spinal Epidural Abscess include:

• Back injury
• Any medical procedure involving the spine
• Infections in the bloodstream
• Boils on the back
• Vertebral osteomyelitis: Infections that occur in the bones of the spine
• Intravenous drug abusers
• Immunodeficiency that is caused by:
  • Diabetes
  • Cancer
  • Excess consumption of alcohol      
  • Acquired Immune Deficiency Syndrome (AIDS) 

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others. 

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Epidural Abscess? (Etiology)

• Epidural Abscess is most commonly caused by the bacterium Staphylococcus aureus
• But fungi, urinary tract infections, and infections of the bloodstream may also be cause of the condition

What are the Signs and Symptoms of Epidural Abscess?

The signs and symptoms of the Epidural Abscess depend on the particular type, whether Intracranial Epidural Abscess or Spinal Epidural Abscess. These may include:

• Signs and symptoms of Spinal Epidural Abscess include:
  • Uncontrolled bowel movements
  • Loss of control over bladder movements    
  • Urinary retention or difficulty while urinating
  • Fever
  • Back pain
• Signs and symptoms of Intracranial Epidural Abscess:
  • Fever
  • Headache
  • Lethargy      
  • Nausea
  • Vomiting
• Neurological symptoms can be caused by either Intracranial or Spinal Epidural Abscess. Depending on the site of the abscess, the neurological symptoms may include:
  • Difficulty in moving any part of the body
  • Decreased sensations in any part of the body
  • Weakness       

How is Epidural Abscess Diagnosed?

A diagnosis of Epidural Abscess may include:

• Complete evaluation of medical history along with a thorough physical exam
• Blood cultures
• CBC or complete blood count
• CT scan of the head, neck, and spine depending upon the abscess site
• MRI scan of the head and spine
• Cerebrospinal fluid (CSF) analysis
• Examination of the drained pus in the laboratory: The pus drainage is usually performed through a fine needle aspiration (FNA) of abscess procedure 

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Epidural Abscess?

The complications depend on the type of Epidural Abscess and these may include:

• Abscess in the brain (Accumulation of pus in the brain)
• Abscess in the spinal cord (Accumulation of pus in the spinal cord)
• Damage to the brain
• Recurrence of infection
• Osteomyelitis or infection of the bone
• Damage to the nerves
• Severe and long-lasting back pain
• Meningitis: Bacterial infection occurring in the membranes covering the brain and spinal cord
• The infection can spread to blood causing septicemia (blood poisoning). This can further cause infection in other parts of the body

How is Epidural Abscess Treated?

The treatment depends on the type of Epidural Abscess, whether intracranial or spinal. In general, the treatment of Epidural Abscess includes:

• Antibiotics:
  • They may be injected through the vein (intravenous antibiotic therapy)
  • Generally prescribed for 4-6 weeks
  • Sometimes, antibiotics may be prescribed for longer durations depending upon the severity of the abscess  
  • A variety of antibiotics may be used
• Surgery is generally recommended to
  • Drain the abscess
  • Reduce pressure on the spinal cord or brain
  • Prevent permanent damage to the organs and consequently to prevent further loss of functions      

How can Epidural Abscess be Prevented?

Preventive measures for Epidural Abscess may include the following:

• Early treatment for certain conditions such as ear infection and sinusitis
• Avoiding illicit drug abuse
• If a boil on the scalp is noticed, seek immediate medical help
• Minimising alcohol consumption can help control diabetes
• Correct diagnosis and immediate treatment can help reducing the risk of serious complications that may arise due to Epidural Abscess.

What is the Prognosis of Epidural Abscess? (Outcomes/Resolutions)

• The prognosis of Epidural Abscess depends upon the type. Generally, the prognosis for Spinal Epidural Abscess is better than that for Intracranial Epidural Abscess
• The mortality rate for Spinal Epidural Abscess is 2-20% and that of Intracranial Epidural Abscess stands at less than 10%
• An early diagnosis and proper treatment will result in good prognosis
• If symptoms, such as weakness, paralysis, and loss of sensations occur, recovery may be difficult

Additional and Relevant Useful Information for Epidural Abscess:

Any medical condition affecting the brain and spine is a very serious issue. It should be immediately treated before any serious complications occur.