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Epidural Abscess

Epidural Abscess is a topic covered in the 5-Minute Emergency Consult.

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Emergency Central

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Basics

Description

  • A rare pyogenic infection of the spinal epidural space
    • 2–25/100,000 admissions
  • Most common in thoracic spine, followed by lumbar and cervical

Etiology

  • Focus of infection is present followed by either hematogenous spread (∼50%) or direct extension
    • No focus identified in ∼1/3
  • Most common source is skin infection:
    • Any pyogenic infection may be source
  • Staphylococcus aureus accounts for >50% of cases:
    • Many are MRSA
    • Streptococcus is 2nd most common
  • Haemophilus influenzae, gram-negative bacilli, mycobacteria, anaerobic, coagulase-negative Staphylococcus, fungal, and mixed infections also occur
  • Complication of epidural catheter or spinal surgery
  • Unusual complication of lumbar puncture (usually follows multiple attempts)

Pediatric Considerations
  • Children present similar to adults with back pain, fever, and neurologic signs as well as nonspecific systemic symptoms
  • Infants may exhibit only fever, irritability, and associated meningitis
  • Sphincter disturbance is frequently seen
  • Usually secondary to hematogenous spread
  • Location and bacteriology similar to adults

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Citation

Rosen, Peter, et al., editors. "Epidural Abscess." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307378/all/Epidural_Abscess.
Epidural Abscess. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307378/all/Epidural_Abscess. Accessed April 23, 2019.
Epidural Abscess. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307378/all/Epidural_Abscess
Epidural Abscess [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307378/all/Epidural_Abscess.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Epidural Abscess ID - 307378 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307378/all/Epidural_Abscess PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -