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Epidural and Subdural Infections Treatment & Management

  • Author: J Stephen Huff, MD, FACEP; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
 
Updated: Aug 12, 2015
 

Prehospital Care

Supportive care, including intravenous access, fluid resuscitation, oxygen, and monitoring, as indicated

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Emergency Department Care

Stabilization procedures may be needed. Most efforts are directed at examination and appropriate imaging for definitive diagnosis. Do not delay antibiotic therapy for imaging procedures or other workup in toxic patients or in those patients with a high likelihood of these disorders or when meningitis remains a possibility in the differential diagnosis. For nontoxic and stable patients, antibiotic therapy is ideally guided by results of abscess aspiration or drainage.

Spinal epidural abscess

Treatment is medical and surgical, with surgery frequently necessary if signs of spinal cord compression are present.

Empiric antibiotic coverage should include an antistaphylococcal penicillin or a cephalosporin.

Empirical antibiotic therapy in most cases should provide coverage against MRSA with vancomycin.[4]

Subdural empyema

Immediate surgical evacuation of the empyema is necessary.

Some controversy exists as to whether a craniotomy flap or multiple burr holes are the superior therapy.

Direct antibiotic therapy against S aureus, the most common pathogen.

If a neurosurgical procedure has recently occurred, combination therapy, as described above, is recommended.

Seizure treatment or prophylaxis may be indicated, depending on the clinical situation.

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Consultations

Expeditious neurosurgical consultation should be initiated when either of these entities is suspected.

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Contributor Information and Disclosures
Author

J Stephen Huff, MD, FACEP Professor of Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia School of Medicine

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

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Barry J Sheridan, DO Chief Warrior in Transition 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.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician, Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Palmetto Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, South Carolina Medical Association, Columbia Medical Society, South Carolina College of Emergency Physicians, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Chief Editor for Medscape.

Additional Contributors

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, Ohio State Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the medical review of this article by Joseph U Becker, MD.

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