Epidural and Subdural Infections Treatment & Management

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

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.[3]

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  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

  1. Tunkel AR. Subdural empyema, epidural abscess, and suppurative intracranial thrombophlebitis. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Disease. Vol 1. Elsevier Churchill Livingstone Inc; 2005:1164-1171.

  2. Hooten WM, Kinney MO, Huntoon MA. Epidural abscess and meningitis after epidural corticosteroid injection. Mayo Clin Proc. May 2004;79(5):682-6. [Medline].

  3. Darouiche RO. Spinal epidural abscess. N Engl J Med. Nov 9 2006;355(19):2012-20. [Medline].

  4. Bluman EM, Palumbo MA, Lucas PR. Spinal epidural abscess in adults. J Am Acad Orthop Surg. May-Jun 2004;12(3):155-63. [Medline].

  5. 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. May-Jun 2007;8(4):338-43. [Medline].

  6. Osman Farah J, Kandasamy J, May P, Buxton N, Mallucci C. Subdural empyema secondary to sinus infection in children. Childs Nerv Syst. Feb 2009;25(2):199-205. [Medline].

  7. Mehta SH, Shih R. Cervical epidural abscess associated with massively elevated erythrocyte sedimentation rate. J Emerg Med. Jan 2004;26(1):107-9. [Medline].

  8. Lefebvre L, Metellus P, Dufour H, Bruder N. Linezolid for treatment of subdural empyema due to Streptococcus: case reports. Surg Neurol. Jan 2009;71(1):89-91; discussion 91. [Medline].

  9. 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. Apr 2004;26(3):285-91. [Medline].

  10. Grewal S, Hocking G, Wildsmith JA. Epidural abscesses. Br J Anaesth. Mar 2006;96(3):292-302. [Medline].

  11. Joshi SM, Hatfield RH, Martin J, Taylor W. Spinal epidural abscess: a diagnostic challenge. Br J Neurosurg. Apr 2003;17(2):160-3. [Medline].

  12. Marsh EB, Chow GV, Gong GX, Rastegar DA, Antonarakis ES. A cut above. Am J Med. Dec 2007;120(12):1031-3. [Medline].

  13. Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev. Dec 2000;23(4):175-204; discussion 205. [Medline].

  14. Rigamonti D, Liem L, Sampath P, et al. Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol. Aug 1999;52(2):189-96; discussion 197. [Medline].

  15. Sendi P, Bregenzer T, Zimmerli W. Spinal epidural abscess in clinical practice. QJM. Jan 2008;101(1):1-12. [Medline].

  16. Siddiq F, Chowfin A, Tight R, Sahmoun AE, Smego RA Jr. Medical vs surgical management of spinal epidural abscess. Arch Intern Med. Dec 13-27 2004;164(22):2409-12. [Medline].

  17. Soehle M, Wallenfang T. Spinal epidural abscesses: clinical manifestations, prognostic factors, and outcomes. Neurosurgery. Jul 2002;51(1):79-85; discussion 86-7. [Medline].

  18. Trombly R, Guest JD. Acute central cord syndrome arising from a cervical epidural abscess: case report. Neurosurgery. Aug 2007;61(2):E424-5; discussion E425. [Medline].

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