Epidural abscess differential diagnosis
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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:
- 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
- Vertebral osteomyelitis - consists in an infection of the bone and bone marrow, concentrated in the spinal region. It may affect two vertebrae and the disc in between and therefore be responsible for the narrowing of the space between the two. The disease may be acute or chronic, however it is more commonly known to be an acute condition. It may manifest with: fever, back pain, swelling, weakness of the vertebral column and surrounding muscles and night sweats. Since some of the symptoms are shared with epidural abscess, this conditions should be in the 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.
- Leukemia - cancer of the blood or bone marrow, characterized by an abnormal proliferation of blood cells, usually leukocytes. Among other signs and symptoms, it may present with bruises, dyspnea, fever, chills, weakness and fatigue, headache and other neurologic symptoms, bone and joint pain. Since some of these are common with epidural abscess, this condition should be included in the differential diagnosis.
- Herpes zoster - (before appearance of skin lesions) commonly known as shingles, consists of a viral disease, characterized by a painful skin rash with blisters on a limited area, usually unilateral, often in a stripe pattern. Signs and symptoms may include fever, headache, chills and tingling sensations. Since some of these are shared with epidural abscess, this condition should be in the differential diagnosis.
- Spinal cord ischemia - consists in the deprivation of blood of a part of the spinal cord. It may arise in numerous settings, namely thrombotic events, following trauma, compression of the arteries from a mass, which can be from an hematoma, abscess, tumor or bone structure. This deprivation can cause different signs and symptoms, depending on the area of the spinal cord affected, such as: radiculopathy, weakness and pain. Since these are shared with epidural abscess, this condition should be included in the 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.