Epidural abscess history and symptoms: Difference between revisions

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{{Epidural abscess}}
{{Epidural abscess}}
{{CMG}}; {{AE}} {{JS}}
{{CMG}} {{AE}} {{JS}}; {{AG}}


==Overview==
==Overview==
An epidural abscess is a rare [[suppurative]] [[infection]] of the [[central nervous system]], a collection of [[pus]] localised in the [[epidural space]] lying outside the [[dura mater]], which accounts for less than 2% of focal [[CNS]] infections. <ref>{{Cite book  | last1 = Longo | first1 = Dan L. (Dan Louis) | title = Harrison's principles of internal medici | date = 2012 | publisher = McGraw-Hill | location = New York | isbn = 978-0-07-174889-6 | pages =  }}</ref> It may occur in two different places: [[intracranial space|intracranially]] or in the [[spinal canal]].  Because the initial [[symptoms]] and clinical characteristics are not always identical and are similar to the ones in other diseases, along with the fact that they are both rare conditions, the final [[diagnosis]] might be delayed in time. This late [[diagnosis]] comes at great cost to the patient, since it is usually accompanied by a bad [[prognosis]] and severe [[complications]] with a potential fatal outcome. The [[diagnosis]] of epidural abscess should be first suspected from the clinical findings and posteriorly supported by laboratory tests and imaging studies, however it can only be confirmed after surgical drainage and proper study of the collected material. According to the location of the collection, the [[abscess]] may have different origins, different organisms involved, [[symptoms]], evolutions, [[complications]] and therapeutical techniques. <ref name="DannerHartman1987">{{cite journal|last1=Danner|first1=R. L.|last2=Hartman|first2=B. J.|title=Update of Spinal Epidural Abscess: 35 Cases and Review of the Literature|journal=Clinical Infectious Diseases|volume=9|issue=2|year=1987|pages=265–274|issn=1058-4838|doi=10.1093/clinids/9.2.265}}</ref><ref name="Darouiche2006">{{cite journal|last1=Darouiche|first1=Rabih O.|title=Spinal Epidural Abscess|journal=New England Journal of Medicine|volume=355|issue=19|year=2006|pages=2012–2020|issn=0028-4793|doi=10.1056/NEJMra055111}}</ref>
A detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include [[immunodeficiency]], [[intravenous drug use]], [[neurosurgery|spinal procedure]], and [[trauma]]. Common symptoms of intracranial epidural abscess include [[headache]], [[fever]], and [[vomiting]]. Common symptoms of spinal epidural abscess include [[back pain]], [[weakness]], and [[Paresthesia|persistent pins and needles]].


==History and Symptoms==
==History==
A detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include:<ref name="pmid11996416">{{cite journal |vauthors=Chao D, Nanda A |title=Spinal epidural abscess: a diagnostic challenge |journal=Am Fam Physician |volume=65 |issue=7 |pages=1341–6 |year=2002 |pmid=11996416 |doi= |url=http://www.aafp.org/link_out?pmid=11996416}}</ref>
*[[Immunodeficiency]]
*[[Diabetes mellitus]]
*[[Alcoholism]]
*[[Intravenous drug use]]
*[[neurosurgery|Spinal procedure]]
*[[Trauma]]
 
==Symptoms==
===Intracranial Epidural Abscess===
===Intracranial Epidural Abscess===
Patients with this tip of epidural abscess usually complain of: <ref name="pmid15043336">{{cite journal| author=Fountas KN, Duwayri Y, Kapsalaki E, Dimopoulos VG, Johnston KW, Peppard SB et al.| title=Epidural intracranial abscess as a complication of frontal sinusitis: case report and review of the literature. | journal=South Med J | year= 2004 | volume= 97 | issue= 3 | pages= 279-82; quiz 283 | pmid=15043336 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15043336  }} </ref>
Common symptoms of intracranial epidural abscess include:<ref name="pmid15043336">{{cite journal| author=Fountas KN, Duwayri Y, Kapsalaki E, Dimopoulos VG, Johnston KW, Peppard SB et al.| title=Epidural intracranial abscess as a complication of frontal sinusitis: case report and review of the literature. | journal=South Med J | year= 2004 | volume= 97 | issue= 3 | pages= 279-82; quiz 283 | pmid=15043336 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15043336  }} </ref>
*[[Headache]]
*[[Headache]]
*[[Fever]]
*[[Fever]]
*[[Vomiting]]
*[[Vomiting]]
*[[Lethargy]]
*[[Confusion]]
*[[Confusion]]
*[[Seizures]]
*[[Seizures]]
*[[Hemiparesis]]
*Partial [[Hemiparesis|paralysis]] of extremities
*[[Frontal bone|Frontal]] [[swelling]]
*[[Frontal bone|Frontal]] [[swelling]]


===Spinal Epidural Abscess===
===Spinal Epidural Abscess===
Patients with this type of epidural abscess usually present with very unspecific [[symptoms]]. However, a triad has been described;
Generally, patients with spinal epidural abscess present with unspecific symptoms. Common symptoms of spinal epidural abscess include:<ref name="pmid3589332">{{cite journal| author=Danner RL, Hartman BJ| title=Update on spinal epidural abscess: 35 cases and review of the literature. | journal=Rev Infect Dis | year= 1987 | volume= 9 | issue= 2 | pages= 265-74 | pmid=3589332 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3589332  }} </ref><ref name="pmid3662166">{{cite journal| author=Mooney RP, Hockberger RS| title=Spinal epidural abscess: a rapidly progressive disease. | journal=Ann Emerg Med | year= 1987 | volume= 16 | issue= 10 | pages= 1168-70 | pmid=3662166 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3662166  }} </ref><ref name="pmid7819646">{{cite journal| author=Liem LK, Rigamonti D, Wolf AL, Robinson WL, Edwards CC, DiPatri A| title=Thoracic epidural abscess. | journal=J Spinal Disord | year= 1994 | volume= 7 | issue= 5 | pages= 449-54 | pmid=7819646 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7819646  }} </ref>
*Fever
*[[Fever]]
*[[Headache]]
*Neurologic deficits
*Neurologic deficits
*Spinal pain
*[[Weakness]]
Despite being an important finding, [[fever]] may not be always present. A possible explanation for this absence it the [[analgesic]] drugs most patients are on, at the time of presentation, for the accompanying [[back pain]]. Therefore, this triad might not be present at all times.<ref name="pmid3589332">{{cite journal| author=Danner RL, Hartman BJ| title=Update on spinal epidural abscess: 35 cases and review of the literature. | journal=Rev Infect Dis | year= 1987 | volume= 9 | issue= 2 | pages= 265-74 | pmid=3589332 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3589332  }} </ref> If untreated, the symptoms usually evolve in a specific order and their progression, within hours to days or months, may be described according to 4 stages: <ref>{{Cite book  | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages =  }}</ref><ref name="Darouiche2006">{{cite journal|last1=Darouiche|first1=Rabih O.|title=Spinal Epidural Abscess|journal=New England Journal of Medicine|volume=355|issue=19|year=2006|pages=2012–2020|issn=0028-4793|doi=10.1056/NEJMra055111}}</ref>
*[[Paresthesia|Persistent pins and needles]]
#[[Back pain|Back]] and focal [[vertebral]] pain, with [[tenderness]] on [[physical exam]].
*[[Back pain]]
#[[Nerve root]] [[pain]], described as being "electric-shock" like, radiating from affected areas, sometimes accompanied by [[paresthesia]].
*[[Fever]]  
#Dysfunction of the [[spinal cord]], presenting by motor and sensory deficits and [[sphincter]] incompetence.
*[[Back pain]]
#[[Paralysis]], which may quickly become irreversible.
*Focal [[vertebral]] pain
*[[Nerve root]] [[pain]]
*Inability to control [[bowels]]
*[[Malaise]]
*Aversion to bright light


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


[[Category:Wikinfect]]
[[Category:Infectious disease]]
[[Category:Disease]]
[[Category:Disease]]
[[Category:Neurology]]
[[Category:Neurology]]
[[Category:Primary care]]

Latest revision as of 21:36, 29 July 2020

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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]; Anthony Gallo, B.S. [3]

Overview

A detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include immunodeficiency, intravenous drug use, spinal procedure, and trauma. Common symptoms of intracranial epidural abscess include headache, fever, and vomiting. Common symptoms of spinal epidural abscess include back pain, weakness, and persistent pins and needles.

History

A detailed and thorough history from the patient is necessary. Specific areas of focus when obtaining a history from the patient include:[1]

Symptoms

Intracranial Epidural Abscess

Common symptoms of intracranial epidural abscess include:[2]

Spinal Epidural Abscess

Generally, patients with spinal epidural abscess present with unspecific symptoms. Common symptoms of spinal epidural abscess include:[3][4][5]

References

  1. ↑ Chao D, Nanda A (2002). "Spinal epidural abscess: a diagnostic challenge". Am Fam Physician. 65 (7): 1341–6. PMID 11996416.
  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.
  3. ↑ Danner RL, Hartman BJ (1987). "Update on spinal epidural abscess: 35 cases and review of the literature". Rev Infect Dis. 9 (2): 265–74. PMID 3589332.
  4. ↑ Mooney RP, Hockberger RS (1987). "Spinal epidural abscess: a rapidly progressive disease". Ann Emerg Med. 16 (10): 1168–70. PMID 3662166.
  5. ↑ Liem LK, Rigamonti D, Wolf AL, Robinson WL, Edwards CC, DiPatri A (1994). "Thoracic epidural abscess". J Spinal Disord. 7 (5): 449–54. PMID 7819646.
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