Epidural Abscess Follow-up

Updated: Mar 28, 2017
  • Author: Mark R Wallace, MD, FACP, FIDSA; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Follow-up

Further Outpatient Care

Follow-up MRI should be obtained if any clinical deterioration is noted in patients with an intracranial epidural abscess or spinal epidural abscess. Follow-up MRI at 2-4 weeks should be performed in patients with spinal epidural abscess undergoing exclusively medical treatment to ensure the abscess has improved. It is unclear whether surgically treated patients with spinal epidural abscess who are doing well require follow-up MRI, as the MRI findings often correlate poorly with the clinical course. [28]

Follow-up with the neurosurgeon is needed.

Follow-up with an infectious diseases specialist is advised to monitor intravenous antibiotics.

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Further Inpatient Care

Frequent neurological examination is warranted during the postsurgical recovery period and is especially critical in patients undergoing medical treatment for spinal epidural abscess.

Fever, leukocytosis, or new neurological deficit necessitates repeated imaging, and further (or initial) surgical exploration may be required. [27]

Follow-up MRIs to evaluate spinal epidural abscess in patients who are doing well may not be helpful, as the findings may not correlate well with clinical course. [28]

Physical therapy may be necessary for individuals with a residual neurological deficit.

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Inpatient & Outpatient Medications

See Treatment and Medication.

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Transfer

In the United States, by law, any unstable patient must be stabilized to the extent possible, including consultation and surgery, if indicated, before transfer.

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Complications

Death or permanent neurologic sequelae occur in a substantial proportion of patients with epidural abscess, especially those who present with major neurological deficits or sepsis.

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Prognosis

The degree of neurologic recovery after surgery correlates with the duration and initial severity of the neurologic defect.

Spinal epidural abscess carries a mortality rate of 2%-20%; intracranial epidural abscess, about 10% (see Mortality).

A worse outcome has been observed in patients with the following: [1]

  • Multiple medical problems
  • Prior spinal surgery
  • Prior cervical or thoracic abscess location
  • Thrombocytopenia
  • Leukocytosis (>14,000 WBCs/µL)
  • Persistently elevated inflammatory markers
  • Infection with methicillin-resistant staphylococci
  • Significant degree of thecal sac compression
  • Sepsis
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Patient Education

For patient education resources, see the Infections Center and Brain and Nervous System Center, as well as Brain Infection and Antibiotics.

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