Epidural and Subdural Infections Follow-up
- Author: J Stephen Huff, MD, FACEP; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD more...
Further Inpatient Care
Spinal epidural abscess: Once diagnosed, further inpatient and outpatient care will be under the direction of the neurosurgeon and/or infectious disease consultant. Generally, if signs of spinal cord compression are present, the treatment includes prompt surgical drainage with antibiotic treatment. If spinal cord compression is not present, some advocate CT-guided abscess aspiration and a prolonged antibiotic course or antibiotic medication alone. Patients must be carefully monitored, and should neurologic dysfunction develop, immediate surgical decompression is recommended.
Subdural empyema: Immediate surgical evacuation is recommended as discussed above. Initiate antibiotic therapy as early as possible and continue through the postoperative period. Antibiotics and duration are at the discretion of the admitting physician.
Transfer to a facility with appropriate resources (neurosurgical and neuroimaging), if necessary. If these infections are suspected, antibiotic therapy should be initiated prior to transfer. Physician-to-physician contact is necessary to coordinate care.
Improving sterile surgical technique for those infections associated with neurosurgical procedures as well as reducing opportunities for hematogenous spread from injection drug use will serve to prevent epidural abscess.
Appropriate and early treatment of sinus infections, prior to invasion into bone, will reduce the occurrence of subdural empyema.
Spinal epidural abscess may impair spinal cord function through compression, although current thinking is that thrombosis of vertebral vessels with secondary infarction of the cord may be the mechanism of injury.
Subdural empyema may precipitate cerebral venous thrombosis or cause increased intracranial pressure, resulting in decreased cerebral perfusion and diffuse cerebral edema. Seizures are common.
An epidural abscess has primary complications of paraplegia or quadriplegia, including all sequelae associated with those conditions. A spinal rehabilitation program may be necessary to minimize long-term problems.
Acute subdural empyema fatality rate is about 40%. Survivors of subdural empyema may develop seizures either in the acute phase or during convalescence.
Tunkel AR. Subdural empyema, epidural abscess, and suppurative intracranial thrombophlebitis. Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Disease. Elsevier Churchill Livingstone Inc; 2010. Vol 1: 1279-1287.
Hooten WM, Kinney MO, Huntoon MA. Epidural abscess and meningitis after epidural corticosteroid injection. Mayo Clin Proc. 2004 May. 79(5):682-6. [Medline].
Kauffman CA, Pappas PG, Patterson TF. Fungal infections associated with contaminated methylprednisolone injections. N Engl J Med. 2013 Jun 27. 368(26):2495-500. [Medline].
Darouiche RO. Spinal epidural abscess. N Engl J Med. 2006 Nov 9. 355(19):2012-20. [Medline].
Bluman EM, Palumbo MA, Lucas PR. Spinal epidural abscess in adults. J Am Acad Orthop Surg. 2004 May-Jun. 12(3):155-63. [Medline].
Ptaszynski AE, Hooten WM, Huntoon MA. The incidence of spontaneous epidural abscess in Olmsted County from 1990 through 2000: a rare cause of spinal pain. Pain Med. 2007 May-Jun. 8(4):338-43. [Medline].
Osman Farah J, Kandasamy J, May P, Buxton N, Mallucci C. Subdural empyema secondary to sinus infection in children. Childs Nerv Syst. 2009 Feb. 25(2):199-205. [Medline].
Mehta SH, Shih R. Cervical epidural abscess associated with massively elevated erythrocyte sedimentation rate. J Emerg Med. 2004 Jan. 26(1):107-9. [Medline].
Davis DP, Salazar A, Chan TC, Vilke GM. Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain. J Neurosurg Spine. 2011 Jun. 14 (6):765-70. [Medline].
Ju KL, Kim SD, Melikian R, Bono CM, Harris MB. Predicting patients with concurrent noncontiguous spinal epidural abscess lesions. Spine J. 2015 Jan 1. 15 (1):95-101. [Medline].
Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis. 2011 Feb 1. 52 (3):285-92. [Medline].
Lefebvre L, Metellus P, Dufour H, Bruder N. Linezolid for treatment of subdural empyema due to Streptococcus: case reports. Surg Neurol. 2009 Jan. 71(1):89-91; discussion 91. [Medline].
Davis DP, Wold RM, Patel RJ, et al. The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess. J Emerg Med. 2004 Apr. 26(3):285-91. [Medline].
Grewal S, Hocking G, Wildsmith JA. Epidural abscesses. Br J Anaesth. 2006 Mar. 96(3):292-302. [Medline].
Joshi SM, Hatfield RH, Martin J, Taylor W. Spinal epidural abscess: a diagnostic challenge. Br J Neurosurg. 2003 Apr. 17(2):160-3. [Medline].
Marsh EB, Chow GV, Gong GX, Rastegar DA, Antonarakis ES. A cut above. Am J Med. 2007 Dec. 120(12):1031-3. [Medline].
Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev. 2000 Dec. 23(4):175-204; discussion 205. [Medline].
Rigamonti D, Liem L, Sampath P, et al. Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol. 1999 Aug. 52(2):189-96; discussion 197. [Medline].
Sendi P, Bregenzer T, Zimmerli W. Spinal epidural abscess in clinical practice. QJM. 2008 Jan. 101(1):1-12. [Medline].
Shah NH, Roos KL. Spinal epidural abscess and paralytic mechanisms. Curr Opin Neurol. 2013 Jun. 26(3):314-7. [Medline].
Siddiq F, Chowfin A, Tight R, Sahmoun AE, Smego RA Jr. Medical vs surgical management of spinal epidural abscess. Arch Intern Med. 2004 Dec 13-27. 164(22):2409-12. [Medline].
Soehle M, Wallenfang T. Spinal epidural abscesses: clinical manifestations, prognostic factors, and outcomes. Neurosurgery. 2002 Jul. 51(1):79-85; discussion 86-7. [Medline].
Trombly R, Guest JD. Acute central cord syndrome arising from a cervical epidural abscess: case report. Neurosurgery. 2007 Aug. 61(2):E424-5; discussion E425. [Medline].