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epidural abscess Definition An epidural abscess is a walled off area of infection in the epidural space. This is the space between the outermost membrane of the brain or spinal cord and the overlying bone and ligaments. What is going on in the body? An epidural abscess is usually caused by the spread of infection from elsewhere in the body. The infection may spread either directly or through the bloodstream. What are the signs and symptoms of the infection? If the abscess is in the head, symptoms may include the following: fatigue fever headache hemiplegia, or weakness on the opposite side of the body The following symptoms can be caused by spinal epidural abscesses: fever localized back pain, which may radiate into the buttocks and legs loss of bowel or bladder control headache and neck pain sudden weakness and loss of feeling below the level of the abscess What are the causes and risks of the infection? An epidural abscess usually results from the spread of infection either directly or through the bloodstream. For example, an infection of the nasal sinuses or an open skull fracture can cause an abscess to develop. Factors that increase a person's risk for an abscess include: bacterial endocarditis, an infection of the heart an implant, such as a pacemaker, that has become infected an infected urinary catheter or intravenous line (IV) osteomyelitis, or bone infection, especially in the vertebrae of the spine a recent sinus infection recent surgery a tooth abscess an upper respiratory infection a urinary tract infection a weakened immune system as a result of diabetes, HIV, or other immunodeficiency disorders What can be done to prevent the infection? Some epidural abscesses can be prevented by effective treatment of the infection that causes it. For example, someone with a sinus infection should finish all prescribed antibiotics. How is the infection diagnosed? Diagnosis of an epidural abscess begins with a history and physical exam. It may be confirmed with a cranial CT scan or cranial MRI . What are the long-term effects of the infection? If the abscess is small and promptly treated, the person may have no long-term effects. If there is extensive damage to the brain, the person may have cognitive impairments, motor impairments, or other problems. If untreated, epidural abscesses may continue to grow. This can put pressure on the surrounding nerves, causing them to lose function. It may also cause the abscess to rupture, spilling its contents into the bloodstream. In any case, the result of an untreated abscess is often death. What are the risks to others? An epidural abscess is not contagious, and poses no risk to others. What are the treatments for the infection? Someone with an epidural abscess will be given antibiotics to treat the infection. Surgery is usually performed to remove the infected tissue from the brain or spinal cord. What are the side effects of the treatments? Antibiotics may cause rash, stomach upset, or allergic reactions. Surgery may cause bleeding, infection, or allergic reaction to anesthesia. Surgery may actually spread the infection if all of the infectious organisms are not removed or destroyed. What happens after treatment for the infection? Recurrent infections may occur if the original source of infection is not completely eliminated. If any infection is noted, it should be identified and treated appropriately. If the person has any impairment from brain damage, he or she may need speech therapy, physical therapy, or occupational therapy. How is the infection monitored? If there has been significant brain damage, the person may need regular visits with healthcare providers. Any new or worsening symptoms should be reported to the provider.

Author: James Warson, MD Date Written: 01/03/00 Reviewer: Barbara Mallari, RN, BSN, PHN Date Reviewed: 08/20/01 Potential conflict of interest information for reviewers available on request