Epidural Abscess

Etiology

  • Hematogenous seeding from systemic bacteremia, as w/endocarditis
  • Or direct extension from adjacent osteomyelitis/discitis
  • Instrumentation/surgery
  • Bacterial: Staph > 60%; then e coli
  • TB and fungal unusual, unless immunocompromised

Risk Factors

  • Etoh
  • Ivdu
  • Other
  • Compromise from dm

Symptoms

  • Fever
  • Progressive acute/subacute pain
  • Site of neuro compromise based on location of abscess: cervical involvement can affect upper and lower extremities, bowel, bladder; lumbar involvement affects lower extremities, bowel, bladder
  • Sensory symptoms include numbness or neuropathic pain
  • Spectrum of extremity motor impairment: from weakness to paralysis
  • Bowel and/or bladder incontinence can occur (or spared)

Physical Exam Findings

  • Fever (sometimes)
  • May have focal pain of vertebrae on palpation at level of infection
  • Neuro findings varied based on level of abscess
  • Sensory symptoms include numbness (upper and/or lower extremities) based on level
  • Motor impairment (upper and/or lower extremities), with weakness to paralysis based on level of involvement and extent compression
  • Saddle anesthesia, decreased rectal tone, urinary retention w/cauda equina

Sub-Diseases

Tests