Epidural abscess pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
According to the location of the epidural abscess, its pathophysiology will differ, particularly in the origin of the infection but also in symptoms, commonly causing organism, progression of the condition and therefore the treatment required. In the case of intracranial epidural abscess, it surges most frequently as a complication of cranial surgical procedures or sinusitis, particularly paranasal sinusitis, as the infection progresses intracranially. [1] On the other hand, spinal epidual abscess happens most frequently due to spinal instrumentation, vascular access and injection drug use. [2]
Pathophysiology
Intracranial Epidural Abscess
Although less common than spinal epidural abscess and with a more indolent evolution, it also requires prompt diagnosis and treatment to avoid severe outcomes. Since intracranial dura mater is adherent to the inner table of the skull, the so-called epidural space is actually a virtual space, which can become a real space by increasing pressure from a liquid, such as pus or blood or a solid mass, such as a tumor. This tight adherence contributes to the slow progression and typical round-shape appearance of the abscess. Because the dura mater is tightly attached to the skull, in the area of the foramen magnum, this abscess is usually restricted to the cranial cavity. On the periphery of the pus collection is created a wall of inflammation, which may calcify and therefore be identified in imaging studies. [1][3]
- Etiologies:
- Paranasal sinusitis, particularly of the frontal sinuses.
- Osteomyelitis of the skull (possible association with Pott's Puffy Tumor.
- Extension of infection from otitis, mastoiditis or orbit.
- Direct inoculation, during a surgical procedure or trauma.
- In pediatric population: scalp venous catheter.
- Remote infection sites, through hematological spread.
- In the case of an intracranial epidural abscess originated in an infection site, such as sinusitis, the organisms may reach the virtual epidural space by several means: [1]
- thrombophlebitis of diploic veins, which is facilitated by the fact that these vessels do not have valves, allowing for retrograde flow of bacteria.
- direct extension from osteomyelitis of the skull.
- following trauma.
- following surgery.
- congenital defect, such as communication between sinuses and areas of lesion.
Spinal Epidural Abscess
References
- ↑ 1.0 1.1 1.2 Fountas KN, Duwayri Y, Kapsalaki E, Dimopoulos VG, Johnston KW, Peppard SB; et al. (2004). "Epidural intracranial abscess as a complication of frontal sinusitis: case report and review of the literature". South Med J. 97 (3): 279–82, quiz 283. PMID 15043336.
- ↑ Strauss I, Carmi-Oren N, Hassner A, Shapiro M, Giladi M, Lidar Z (2013). "Spinal epidural abscess: in search of reasons for an increased incidence". Isr Med Assoc J. 15 (9): 493–6. PMID 24340840.
- ↑ Heran NS, Steinbok P, Cochrane DD (2003). "Conservative neurosurgical management of intracranial epidural abscesses in children". Neurosurgery. 53 (4): 893–7, discussion 897-8. PMID 14519222.