Epidural and Subdural Infections Follow-up

  • Author: J Stephen Huff, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: May 2, 2011
 

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 immediate 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.
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Transfer

  • 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.
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Deterrence/Prevention

  • 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.
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Complications

  • 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.
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Prognosis

  • 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.
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Contributor Information and Disclosures
Author

J Stephen Huff, MD  Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center

J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Mark S Slabinski, MD, FACEP, FAAEM  Vice President, EMP Medical Group

Mark S Slabinski, MD, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Ohio State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Barry J Sheridan, DO  Chief, Department of Emergency Medical Services, Brooke Army Medical Center

Barry J Sheridan, DO is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

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Spinal epidural abscess with cord edema and compression. Abscess extends into paravertebral tissues.
 
 
 
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