Epidural abscess differential diagnosis: Difference between revisions
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| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[radiculopathy]], [[weakness]] and [[pain]]. | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[radiculopathy]], [[weakness]] and [[pain]]. | ||
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[ | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Vertebral osteomyelitis]]''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Presents with | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with infected [[bone]] and [[bone marrow]], [[fever]], [[back pain]], [[swelling]], [[weakness]] of the [[vertebral column]] and surrounding [[muscles]], and [[night sweats]]. | ||
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| style="padding: 5px 5px; background: #DCDCDC;" | '''[[ | | style="padding: 5px 5px; background: #DCDCDC;" | '''[[Leukemia]]''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[ | | style="padding: 5px 5px; background: #F5F5F5;" | Presents with [[bruises]], [[dyspnea]], [[fever]], [[chills]], [[weakness]], [[fatigue]], [[headache]], and [[bone pain|bone]] and [[joint pain]]. | ||
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*'''[[Meningitis]]''' - consists in the [[inflammation]] of the [[meninges]], as a response to [[infectious agents]], certain [[drugs]], [[trauma]] or [[cancer]]. The [[inflammatory]] process will cause [[signs]] and [[symptoms]] such as [[headache]], [[back pain]], [[nuchal rigidity]], [[fever]] and [[altered mental status]], which are similar to those of [[epidural abscess]], and why [[meningitis]] should be on the differential diagnosis. | *'''[[Meningitis]]''' - consists in the [[inflammation]] of the [[meninges]], as a response to [[infectious agents]], certain [[drugs]], [[trauma]] or [[cancer]]. The [[inflammatory]] process will cause [[signs]] and [[symptoms]] such as [[headache]], [[back pain]], [[nuchal rigidity]], [[fever]] and [[altered mental status]], which are similar to those of [[epidural abscess]], and why [[meningitis]] should be on the differential diagnosis. | ||
*'''[[Bone]] [[tuberculosis]]''' - a presentation of extrapulmonary [[tuberculosis]], affecting the [[bones]], most often the [[spine]] ([[Pott's disease]], at the level of lower thoracic and upper lobar [[vertebrae]]. It results from an hematogenous spread of the organism from other sites, commonly the [[lung]]. It may have various [[signs]] and [[symptoms]], from which back [[pain]], [[fever]] and [[weakness]] are common to the [[epidural abscess]], making this an important element of the differential diagnosis.{{Seealso|Pott's disease}} | *'''[[Bone]] [[tuberculosis]]''' - a presentation of extrapulmonary [[tuberculosis]], affecting the [[bones]], most often the [[spine]] ([[Pott's disease]], at the level of lower thoracic and upper lobar [[vertebrae]]. It results from an hematogenous spread of the organism from other sites, commonly the [[lung]]. It may have various [[signs]] and [[symptoms]], from which back [[pain]], [[fever]] and [[weakness]] are common to the [[epidural abscess]], making this an important element of the differential diagnosis.{{Seealso|Pott's disease}} | ||
*' | *' | ||
*'''Primary or [[metastatic]] [[tumor]]''' - consists in any [[tumor]] arising from the [[spinal cord]], or elsewhere in the body, which metastasises to the [[spinal cord]]. Depending on its location, it may be classified as: ''extradural'', ''intramural'' or ''intramedullary'' [[spinal tumor]]. It will create a [[mass effect]], which will compress the [[spinal cord]] and weaken the [[vertebral]] structure, causing [[signs]] and [[symptoms]], such as: [[incontinence]], [[weakness]] in the saddle area and [[back pain]]. Therefore it should also be included in this differential diagnosis. | *'''Primary or [[metastatic]] [[tumor]]''' - consists in any [[tumor]] arising from the [[spinal cord]], or elsewhere in the body, which metastasises to the [[spinal cord]]. Depending on its location, it may be classified as: ''extradural'', ''intramural'' or ''intramedullary'' [[spinal tumor]]. It will create a [[mass effect]], which will compress the [[spinal cord]] and weaken the [[vertebral]] structure, causing [[signs]] and [[symptoms]], such as: [[incontinence]], [[weakness]] in the saddle area and [[back pain]]. Therefore it should also be included in this differential diagnosis. | ||
* | * | ||
==References== | ==References== | ||
Revision as of 20:23, 9 November 2015
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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
Intracranial epidural abscess must be differentiated from epidural hematoma, subdural empyema, brain abscess, tuberculous meningitis, and other intracranial mass lesions. Spinal epidural abscess must be differentiated from other conditions that cause back pain, motor weakness, and/or spinal tenderness, such as arthritis, osteoarthritis, intervertebral disc disease, vertebral osteomyelitis, primary or metastatic tumors, and musculoskeletal pain.
Differential Diagnosis
Intracranial Epidural Abscess
Intracranial epidural abscess must be differentiated from other diseases that cause headache, vomiting, fever, altered mental status, seizures, cranial nerve abnormalities, and paresis.[1] Intracranial epidural abscess must be differentiated from:
Spinal Epidural Abscess
Spinal epidural abscess must be differentiated from other diseases that cause back pain, fever, motor weakness, and spinal tenderness.[2][3][4][5] Therefore, spinal epidural abscess must be differentiated from:
| Disease | Findings |
|---|---|
| Musculoskeletal pain | Presents with lower back pain following overuse and over stretching of muscles, or in the context of a viral infection. |
| Arthritis and Osteoarthritis | Presents with back pain, stiffness, tenderness, and weakness. |
| Degenerative disc disease | Presents with lower back pain, [[[tenderness]], and weakness. |
| Spinal disc herniation | Presents with the soft central nucleus pulposus to bulging out, lower back pain, leg pain, tingling, numbness, and reflex changes. |
| Shingles | Presents with painful skin rash, blisters, fever, headache, chills, and tingling sensations. |
| Spinal cord ischemia | Presents with radiculopathy, weakness and pain. |
| Vertebral osteomyelitis | Presents with infected bone and bone marrow, fever, back pain, swelling, weakness of the vertebral column and surrounding muscles, and night sweats. |
| Leukemia | Presents with bruises, dyspnea, fever, chills, weakness, fatigue, headache, and bone and joint pain. |
- Epidural hematoma - consists in the buildup of blood in the epidural space, between the dura mater and the inner bone surface of the skull or spinal canal. It may cause headache or back pain, depending on the location of the hematoma, confusion, weakness, focal neurologic signs and others. Since many of this signs and symptoms are shared with the epidural abscess, this conditions should be included in the differential diagnosis.
- Meningitis - consists in the inflammation of the meninges, as a response to infectious agents, certain drugs, trauma or cancer. The inflammatory process will cause signs and symptoms such as headache, back pain, nuchal rigidity, fever and altered mental status, which are similar to those of epidural abscess, and why meningitis should be on the differential diagnosis.
- Bone tuberculosis - a presentation of extrapulmonary tuberculosis, affecting the bones, most often the spine (Pott's disease, at the level of lower thoracic and upper lobar vertebrae. It results from an hematogenous spread of the organism from other sites, commonly the lung. It may have various signs and symptoms, from which back pain, fever and weakness are common to the epidural abscess, making this an important element of the differential diagnosis.Template:Seealso
- '
- Primary or metastatic tumor - consists in any tumor arising from the spinal cord, or elsewhere in the body, which metastasises to the spinal cord. Depending on its location, it may be classified as: extradural, intramural or intramedullary spinal tumor. It will create a mass effect, which will compress the spinal cord and weaken the vertebral structure, causing signs and symptoms, such as: incontinence, weakness in the saddle area and back pain. Therefore it should also be included in this differential diagnosis.
References
- ↑ 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.
- ↑ Grewal, S. (2006). "Epidural abscesses". British Journal of Anaesthesia. 96 (3): 292–302. doi:10.1093/bja/ael006. ISSN 0007-0912.
- ↑ Maslen DR, Jones SR, Crislip MA, Bracis R, Dworkin RJ, Flemming JE (1993). "Spinal epidural abscess. Optimizing patient care". Arch Intern Med. 153 (14): 1713–21. PMID 8333809.
- ↑ Ngan Kee WD, Jones MR, Thomas P, Worth RJ (1992). "Extradural abscess complicating extradural anaesthesia for caesarean section". Br J Anaesth. 69 (6): 647–52. PMID 1467114.
- ↑ Keon-Cohen BT (1968). "Epidural abscess simulating disc hernia". J Bone Joint Surg Br. 50 (1): 128–30. PMID 5641580.