Epidural Abscess - An Overview

What Is Epidural Abscess?

Infections called intracranial epidural abscesses develop in the area between the skull bones and the brain's lining. A spinal epidural abscess is a condition that frequently develops in the gap between the spinal column's lining membrane and its bony structure.

A pocket of pus accumulates and causes swelling due to an epidural abscess. The membranes (meninges) that guard the spine, brain, and bones may come into contact with it. This swelling may impact physical movement and sensations with the underlying infection, resulting in additional issues. Treatment must be started right away for an epidural abscess.

What Are the Causes of the Condition?

Epidural abscess is a rare condition caused by infection between the bones of the cranium or spine and the membranes that cover the brain or spinal cord (meninges). This infection is called a cerebral epidural abscess within the skull. If the abscess is located in the spine, it is termed a spinal epidural abscess. Most can be found in the spine.

Usually, bacteria are responsible for spinal infection, but fungi may also be to blame. It can be caused by other infections within the body (primarily an infection of the urinary tract) or blood-borne pathogens.

Intracranial epidural abscess is the name given to an abscess inside the cranium. Any of the following could be the cause:

• Persistent otitis media (an illness that affects the inner ear space. Otitis media with effusion (OME), acute otitis media (AOM), and chronic suppurative otitis media (CSOM) are all subtypes of the same spectrum of disorders known as otitis media).

• Sinusitis chronique (inflammation of the nasal passages or sinuses that lasts twelve weeks as chronic sinusitis).

• Head injury.

• Mastoiditis (an infection of the mastoid process, the prominent bone behind the ear).

• Recent neurosurgery.

• Spinal epidural abscess refers to an infection of the spine.

It may occur in any of these conditions:

• Had a back operation or other invasive surgery involving the spine.

• Infections of the blood.

• Boils, notably on the back and skull.

• Injecting drug users are also at an increased risk for vertebral osteomyelitis, an infection of the vertebrae.

What Are the Diagnostic Methods?

If a patient experiences symptoms associated with an epidural abscess, the attending physician may recommend that they undergo magnetic resonance imaging (MRI).

• MRI - An MRI, or magnetic resonance imaging, is a type of imaging that utilizes a combination of strong magnets, radio waves, and a computer to produce extremely detailed images of the internal organs and structures of the human body.

• Blood Examination - For the physician to determine whether or not the patient is suffering from an infection, patients need to get a complete blood count (CBC) through a blood sample. If there is a medical problem present, there will be a rise in the number of white blood cells. This is because the organisms that cause infections are fought and destroyed by white blood cells in the body. If this is the case, then blood cultures can be used to determine the specific bacteria or fungus responsible for the patient's infection.

What Are the Signs and Symptoms?

The signs and symptoms that accompany an epidural abscess vary based on its location. These symptoms may be the result of an epidural abscess:

• Headache.

• Discomfort in the mind.

• Fever.

• Unusual sensations throughout the entire body.

• Coordination and motion difficulties.

• Trouble navigating.

• Muscular weakness in the limbs and legs progressively worsens.

• Paralysis is the inability to move one's limbs or legs.

• Back discomfort.

• Inability to control excretion and bladder.

• Feeling queasy or throwing up.

• Extremely weary and lethargic.

What Are the Treatment Methods?

1. Conventional Therapy

• The conventional therapy for spinal epidural abscesses involves surgery in addition to the administration of antibiotics or antifungals.

• Antibiotics could be the sole therapy option available in certain circumstances. In most cases, the duration of antibiotic treatment is between four and six weeks.

2. Surgical Intervention

• If the abscess exerts stress on the column of the vertebrae, the surgeon will use surgical procedures to decompress the spinal cord to alleviate the pressure.

• To access the spinal cord, the surgeon may perform a procedure known as a laminectomy (an operation aimed at removing the lamina from the spine; it is a piece of the bone that is a component of one of the vertebrae in the spine).

• This involves removing the lamina, which is the bone that covers the spinal canal by removing the lamina to make room for the vertebral column, which in turn enables the column to operate normally after the procedure. In most cases, a laminectomy is required when treating complicated infections.

3. In Case of Abscess

• If the abscess develops neurological symptoms such as malfunction of the bladder or intestine, as observed in cauda equina syndrome (a condition that develops when many lumbar spines in the cauda equina become dysfunctional), a doctor will rapidly drain the abscess; these symptoms can be seen in people who have cauda equina syndrome.

• After an abscess has been completely drained, the medical professional will want to take a culture to determine which treatments will be the most helpful in treating the particular organism causing the infection.

What Is the Consequence of This Condition?

In the absence of therapy, potentially life-threatening consequences may arise, including the following:

• Meningitis is an inflammation that affects a person's meninges.

• The vertebral column itself has developed an abscess.

• Infection that affects the spinal column or the bones of the skull.

• Long-term back discomfort.

• Permanent injury to the nerve system or brain, which may result in paralysis if left untreated.

If the nervous system has already been damaged, it may be difficult, if not impossible, to get it back to its normal functioning state. Epidural abscesses that go untreated can be exceedingly harmful and could lead to death in some cases.

Conclusion

Intracranial epidural abscesses are infections in the area between the skull bones and brain lining. Spinal epidural abscesses grow between the spinal cord's lining membrane and the spine's bones. It can also occur within the lumbar spine. Some patients' neurological recovery shows the benefit of early diagnosis and therapy. Early diagnosis is crucial to successful management; thus, involved professionals must consider it. Any patient having an unknown infection should have repeated spinal, including neurological tests and a comprehensive investigation if they have spinal pain or soreness. MRI may enable early diagnosis as lower morbidity with this illness in a few years.