Epidural abscess physical examination: 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>
Physical examination of patients with epidural abscess is usually remarkable for [[fever]], [[back pain]], and generally well appearance, often contributing to misdiagnosis.  


==Physical Examination==
==Physical Examination==
On the physical examination of a patient with subdural empyema, the physician might find:
Physical examination of patients with epidural abscess is usually remarkable for the following:<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><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><ref name=Mandell>{{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=Schlossberg>{{cite book | last = Schlossberg | first = David | title = Clinical infectious disease | publisher = Cambridge University Press | location = Cambridge New York | year = 2008 | isbn = 9780521871129 }}</ref>
===Intracranial Epidural Abscess===
 
===General appearance===
Patient generally appears complaining of [[malaise]] and [[fever]].
 
===Vital signs===
*[[Fever]]
*[[Fever]]
*Altered mental status
*[[Normotension]]
*[[Seizures]]
*[[Hemiparesis]]


===HEENT===
*[[Cranial nerve]] [[signs]]
*[[Cranial nerve]] [[signs]]
*[[Periorbital cellulitis]]
*[[Periorbital cellulitis]]
*[[Frontal bone|Frontal swelling]]
*[[Frontal bone|Frontal swelling]]
*[[Sinusitis]]
*[[Otitis]]
===Back===
*[[Back pain]]
===Extremities===
*Focal [[pain]] radiating from back


===Spinal Epidural Abscess===
===Neuromuscular===
*[[Fever]]
*Altered [[mental status]]
*[[Seizures]]
*[[Hemiparesis]]
*[[Hemiparesis]]
*[[Weakness]]
*Altered [[reflexes]]
*[[Paresthesia]]
*[[Paralysis]]
*[[Spinal cord]] dysfunction, with [[sphincter]] incompetence and sensory and motor deficits
*[[Meningism]]


==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

Physical examination of patients with epidural abscess is usually remarkable for fever, back pain, and generally well appearance, often contributing to misdiagnosis.

Physical Examination

Physical examination of patients with epidural abscess is usually remarkable for the following:[1][2][3][4]

General appearance

Patient generally appears complaining of malaise and fever.

Vital signs

HEENT

Back

Extremities

  • Focal pain radiating from back

Neuromuscular

References

  1. Darouiche, Rabih O. (2006). "Spinal Epidural Abscess". New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 0028-4793.
  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. Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0-443-06839-9.
  4. Schlossberg, David (2008). Clinical infectious disease. Cambridge New York: Cambridge University Press. ISBN 9780521871129.