Epidural and Subdural Infections Clinical Presentation
- Author: J Stephen Huff, MD, FACEP; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD more...
Spinal epidural abscess
Early presentations may be subtle, and diagnosis may be difficult, if not impossible, at early stages.
History of fever is often but not invariably present.
Localized back pain may be present.
If present, neurologic deficit is consistent with a spinal cord syndrome.
History may suggest a source or cause of infection (eg, soft tissue infection, intravenous drug abuse, indwelling catheters, recent epidural injections, neurosurgical procedures or other instrumentation).
Duration of symptoms is typically a few days but may extend over weeks. Symptom onset may also be abrupt.
Radicular pain consistent with nerve root irritation may confound evaluation, particularly if the pain occurs in the abdomen or the chest.
Progressive sensory disturbances in the extremities, weakness, and incontinence suggest progression to spinal cord involvement.
An immunosuppressive condition, such as diabetes, alcoholism, HIV infection, or chronic liver or kidney disease, is often present.
Headaches may be initially unilateral but then become generalized.
Fever and vomiting may be present.
Focal or generalized seizures may be present.
Tempo of clinical course usually is fulminant with rapid deterioration.
Unusual indolent courses may follow neurosurgical procedures.
A history of recent sinusitis or otitis media may be present.
Antibiotic therapy may lessen systemic symptoms.
Both spinal epidural abscess and subdural empyema may manifest generalized signs and symptoms of infection such as fever, sepsis, or septic shock.
Spinal epidural abscess
Localized tenderness to percussion or palpation over the involved region may or may not be present.
Signs of spinal cord dysfunction, such as loss of sphincter tone, sensory loss, or localized motor weakness are late findings.
Reflexes may vary from hypoactive or absent to brisk and spastic.
An abnormal postvoiding residual volume may be a sign of spinal cord disfunction.
Focal neurologic deficit or focal seizures may be present in a patient with signs of meningeal irritation.
Altered mental status is present in most patients.
Focal neurologic signs, such as hemiparesis or aphasia, may precede further alteration in consciousness.
Papilledema is absent in most patients, reflecting a short duration of increased intracranial pressure.
Spinal epidural abscess
Most cases arise from hematogenous seeding of the epidural space from a distant source of infection.
Another etiology is extension of infection from adjacent vertebral osteomyelitis or discitis.
Penetrating trauma, recent neurosurgical procedures, or recent epidural injections or catheter placements are other causes.
Staphylococcus aureus is the most frequent bacteriologic cause, with methicillin-resistant S aureus (MRSA) being increasingly reported.
Most cases are extensions of infections from the paranasal sinuses.
Recent neurosurgical procedures and penetrating trauma cause other cases.
Hematogenous spread of infection from a pulmonary source also has been reported.
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