Intracranial Epidural Abscess Follow-up

Updated: Nov 12, 2014
  • Author: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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Follow-up

Complications

See the list below:

  • Seizures
  • Uncal or tonsillar herniation due to increased ICP
  • Hemorrhage into the abscess
  • Spread of infection: The infection may spread into the bones of the skull, resulting in osteomyelitis. It may also spread deeper because of spread of infection along the emissary veins, causing subdural empyema, meningitis, and intraparenchymal brain abscess or even a spinal cord abscess.
  • Septic shock
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Prognosis

See the list below:

  • Because of the insidious onset of symptoms, neuroimaging by CT scanning and MRI, as well as the availability of strong antibiotics have resulted in decreased morbidity and mortality from this condition in recent years.
  • Signs associated with an excellent prognosis include the following:
    • Young age
    • No altered mental status
    • Absence of severe neurologic deficit on initial presentation
    • Absence of neurologic deterioration during initial management
    • No comorbid factors
  • Poorer prognosis is often associated with the following:
    • Signs of herniation present on initial presentation, when the mortality rate exceeds 50%
    • Failure to obtain a brain CT scan in patients with altered mental status, headache, or new neurologic deficit
    • Failure to address family concerns about unusual patient behavior, especially when other symptoms indicative of intracranial epidural abscess are present
  • Early and accurate diagnosis of this potentially invalidating but treatable disease is of paramount importance.
  • Pradilla et al report that prognosis for both spinal epidural abscesses and intracranial epidural abscesses is typically poor because of delayed diagnosis and intervention and that prognosis largely depends on the neurologic status at the time of diagnosis. Increased clinical awareness can help achieve an earlier diagnosis, thereby greatly improving outcomes. [15]
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Patient Education

For excellent patient education resources, visit eMedicineHealth's Infections Center and Brain and Nervous System Center. Also, see eMedicineHealth's patient education articles Brain Infection, Antibiotics, and Spinal Tap.

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