Epidural abscess (intracranial)
Revision as of 00:31, 2 October 2019 by ClaireLewis (talk | contribs)
Background
- Much less common than spinal epidural abscess (1:9)
- Usually caused by local spread of infection or inoculation during surgery or trauma
- Usually isolated to calvarium due to adherence of dura to foramen magnum
Clinical Features
Differential Diagnosis
Intracranial Mass
- Intracranial hemorrhage
- Intra-axial
- Hemorrhagic stroke (Spontaneous intracerebral hemorrhage)
- Traumatic intracerebral hemorrhage
- Extra-axial
- Epidural hemorrhage
- Subdural hemorrhage
- Subarachnoid hemorrhage (aneurysmal intracranial hemorrhage)
- Intra-axial
- Brain tumor
- Brain abscess
- Subdural empyema
- Epidural abscess (intracranial)
Evaluation
- Suspect diagnosis based on clinical history and physical exam
- Imaging modality of choice is MRI
- CT with IV contrast is reasonable alternative
Management
- Surgical decompression
- Antibiotics
- Vancomycin + metronidazole + (cefotaxime or ceftriaxone or ceftazidime)
- Ceftazidime is preferred if pseudomonas is considered likely
- Can substitute nafcillin or oxacillin for Vancomycin if not MRSA
- Treat for 6-8 weeks
- If likely nasopharyngeal source (sinusitis, mastoiditis), may consider regiment covering strep, Haemophilus influenzae, and aerobes
- Vancomycin + metronidazole + (cefotaxime or ceftriaxone or ceftazidime)
Disposition
- Admit