Epidural Abscess

An epidural abscess is an infection that forms in the space between the skull bones and the brain lining (intracranial epidural abscess) or in the space between the bones of the spine and the lining membrane of the spinal cord (spinal epidural abscess).

An epidural abscess results in a pocket of pus that builds up and causes swelling. It can press against the bones and the meninges, which are the membranes that protect the spinal cord and the brain. This swelling and the underlying infection can affect sensations and physical movement.

Facts about epidural abscess

Although it can also affect the brain, an epidural abscess is more likely to strike the spinal cord. Typically, an epidural abscess is caused by a bacterial infection, usually Staphylococcus aureus, but it could be from a fungus or another germ circulating in your body. Much of the time, doctors can't find a particular cause of the infection. Sometimes, they can't even identify a risk factor.

If you suffer from persistent sinus or ear infections or have had an injury to the head, you may be more likely to develop an epidural abscess inside the skull. You're more likely to develop an epidural abscess on the spine if you have an infection in the bones of the spine or in your blood, or have had a surgical procedure on your back.

Types of epidural abscess

The different types of epidural abscesses specify where they are found:

  • An intracranial epidural abscess is located inside the skull.

  • A spinal epidural abscess is located on the spine.

Symptoms

An epidural abscess may cause these symptoms:

  • Headache

  • Disturbed consciousness

  • Fever

  • Unusual sensation throughout your body

  • Problems with coordination and movement

  • Difficulty walking, sometimes as severe as paralysis—being unable to move the legs or arms

  • General weakness of the muscles in both the arms and legs that worsens

  • Pain in the back

  • Inability to control your bowels or bladder

  • Feeling nauseated and/or vomiting

  • Feeling very tired and sluggish

Diagnosis

A doctor may use several tests to look at the spine and brain and the infected area to diagnose an epidural abscess, including:

  • MRI scan

  • CT scan

  • Sample of fluid from the abscessed area to determine the cause of the infection

Treatment

Typically, you will be given antibiotics to fight the infection that caused the abscess. A surgeon may need to drain the fluid from the abscess with a needle to help alleviate the pressure, or he or she may remove it entirely. Surgery is generally required when moving is difficult, you are unable to move at all, or you have sensation problems, such as numbness somewhere in the body.

Calling the doctor

Treatment of an epidural abscess is essential. If you’re feeling back pain, having any neurological problems, or are running a fever along with a bad headache, call your doctor and have the problem treated promptly.

Prevention

Get fast treatment for any infection. Being treated for illnesses such as blood infections, sinus infections, and ear infections can help reduce your risk of developing an epidural abscess.

Complications

Without treatment, serious complications can set in:

  • Meningitis, an infection of the meninges

  • Abscess of the spinal cord itself

  • Infection inside the spine or skull bones

  • Abscess in the brain

  • Long-term back pain

  • Irreversible damage to the brain or nervous system, including paralysis

Once damage to the nervous system has occurred, it can be difficult to restore normal nervous system function. Untreated epidural abscess can be extremely dangerous and may result in death.

Key points to remember

When you're facing an infection that's directly affecting your brain or spine, it's a serious health issue. Any unusual symptoms related to loss of sensation, trouble moving, and fever—particularly if you've recently been ill—should be quickly evaluated. The sooner you treat an epidural abscess, the better the outcome.