Epidural and Subdural Infections Workup

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

Laboratory Studies

  • Sedimentation rate is often elevated and advocated by some as a screening laboratory test.[7]
  • CBC may reveal a high WBC count (but normal WBC counts reported as well).
  • Other tests may include blood cultures, electrolyte levels, and preoperative laboratory studies (as needed by neurosurgery, eg, prothrombin time [PT], activated partial thromboplastin time [aPTT], ECG, chest radiograph [CXR]).
  • Postsurgical tissue/fluid cultures of infected space may be indicated.
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Imaging Studies

Spinal epidural abscess

Immediate imaging of the spinal cord is needed. Techniques that are immediately available vary at different institutions.

MRI with gadolinium contrast is the procedure of choice because of the noninvasive nature of the test. It also delineates the extent of the abscess, which frequently extends over several levels.

For patients with paraplegia, it is prudent to image the lumbar and thoracic spine because of the bony spine and spinal cord anatomy. Thoracic spine lesions may cause paraplegia and lumbar neurologic symptoms, and imaging confined to the lumbar area may not demonstrate cord compression.

CT scan myelography or conventional myelography may be used if MRI is unavailable.

Subdural empyema

Cranial CT scan is the modality of choice.

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Procedures

  • Lumbar puncture: Lumbar puncture (LP) is relatively contraindicated in both conditions because of the risk of precipitating shifts of CNS content in the presence of a mass lesion. However, LP often is performed in the course of patient evaluation, particularly since meningitis is in the differential diagnosis. A typical cerebrospinal fluid (CSF) profile for parameningeal infections would reveal only a few inflammatory cells with elevated protein level and decreased glucose level.
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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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