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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, being 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>


==X Ray==
Despite the fact that the [[X-Ray]] is not an ideal imaging test to study the [[epidural abscess]], it is useful to evaluate possible [[skull fractures]], [[osteomyelitis]] lesions, [[discitis]] or [[foreign bodies]] lodged in the [[skull]] or [[spine]], which might be the source of the [[infection]]. <ref name="Hendaus2013">{{cite journal|last1=Hendaus|first1=Mohammed A.|title=Subdural Empyema in Children|journal=Global Journal of Health Science|volume=5|issue=6|year=2013|issn=1916-9744|doi=10.5539/gjhs.v5n6p54}}</ref> Despite the fact that [[epidural abscesses]] are not normally seen in [[X Ray]]s, a study from David R. Maslen ''et all'', showed that in 30% of the cases, the [[X Ray]] showed some kind of abnormality in these patients, often reporting degenerative changes, [[vertebral]] end-plate destruction or narrowing of the [[Intervertebral disc|disc]] space. <ref name="pmid8333809">{{cite journal| author=Maslen DR, Jones SR, Crislip MA, Bracis R, Dworkin RJ, Flemming JE| title=Spinal epidural abscess. Optimizing patient care. | journal=Arch Intern Med | year= 1993 | volume= 153 | issue= 14 | pages= 1713-21 | pmid=8333809 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8333809  }} </ref>


In the case of '''[[myelography]]''', despite the increased [[sensitivity]] to diagnose [[epidural abscess]], the invasiveness of this technique and possible [[complications]] give more relevance to the [[MRI]].<ref name="Grewal2006">{{cite journal|last1=Grewal|first1=S.|title=Epidural abscesses|journal=British Journal of Anaesthesia|volume=96|issue=3|year=2006|pages=292–302|issn=0007-0912|doi=10.1093/bja/ael006}}</ref>
==Other Imaging Findings==
===X Ray===
[[X ray]] is not an ideal imaging test to study epidural abscess. X ray is useful in evaluating possible [[skull fractures]], [[osteomyelitis]] lesions, [[discitis]], or [[foreign bodies]] lodged in the [[skull]] or [[spine]], which may be the source of the [[infection]].<ref name="Hendaus2013">{{cite journal|last1=Hendaus|first1=Mohammed A.|title=Subdural Empyema in Children|journal=Global Journal of Health Science|volume=5|issue=6|year=2013|issn=1916-9744|doi=10.5539/gjhs.v5n6p54}}</ref> In 30% of patients with epidural abscess, radiography demonstrated some abnormality in these patients, often reporting degenerative changes, [[vertebral]] end-plate destruction, or narrowing of the [[intervertebral disc]] space.<ref name="pmid8333809">{{cite journal| author=Maslen DR, Jones SR, Crislip MA, Bracis R, Dworkin RJ, Flemming JE| title=Spinal epidural abscess. Optimizing patient care. | journal=Arch Intern Med | year= 1993 | volume= 153 | issue= 14 | pages= 1713-21 | pmid=8333809 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8333809  }} </ref>


[[Image:L5-S1 intervertebral narrowing.jpg|thumb|center|Intervertebral narrowing at the level of L5-S1, with concomitant sclerosis of vertebral plateau]]


'''Image courtesy of Radiopaedia [http://www.radiopaedia.org]'''
[[Image:L5-S1 intervertebral narrowing.jpg|left|200px|thumb|Intervertebral narrowing at the level of L5-S1, with concomitant sclerosis of vertebral plateau<ref name=SEAXRay> Image courtesy of Dr Maxime St-Amant. [http://www.radiopaedia.org Radiopaedia] (original file [http://radiopaedia.org/cases/spondylodiscitis-l5-s1-with-epidural-abscesses "here"]). [http://radiopaedia.org/licence Creative Commons BY-SA-NC]</ref>]]
<br><br><br><br><br><br><br><br><br><br><br><br><br>
 
===Myelography===
Myelography may be helpful in the diagnosis of epidural abscess. However, the invasiveness of this technique and possible [[complications]] give more relevance to the [[MRI]].<ref name="Grewal2006">{{cite journal|last1=Grewal|first1=S.|title=Epidural abscesses|journal=British Journal of Anaesthesia|volume=96|issue=3|year=2006|pages=292–302|issn=0007-0912|doi=10.1093/bja/ael006}}</ref>


==References==
==References==

Revision as of 20:39, 16 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

Other Imaging Findings

X Ray

X ray is not an ideal imaging test to study epidural abscess. X ray is useful in evaluating possible skull fractures, osteomyelitis lesions, discitis, or foreign bodies lodged in the skull or spine, which may be the source of the infection.[1] In 30% of patients with epidural abscess, radiography demonstrated some abnormality in these patients, often reporting degenerative changes, vertebral end-plate destruction, or narrowing of the intervertebral disc space.[2]


Intervertebral narrowing at the level of L5-S1, with concomitant sclerosis of vertebral plateau[3]














Myelography

Myelography may be helpful in the diagnosis of epidural abscess. However, the invasiveness of this technique and possible complications give more relevance to the MRI.[4]

References

  1. ↑ Hendaus, Mohammed A. (2013). "Subdural Empyema in Children". Global Journal of Health Science. 5 (6). doi:10.5539/gjhs.v5n6p54. ISSN 1916-9744.
  2. ↑ 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.
  3. ↑ Image courtesy of Dr Maxime St-Amant. Radiopaedia (original file "here"). Creative Commons BY-SA-NC
  4. ↑ Grewal, S. (2006). "Epidural abscesses". British Journal of Anaesthesia. 96 (3): 292–302. doi:10.1093/bja/ael006. ISSN 0007-0912.
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