Epidural Abscess of the Central Nervous System

Epidural AbscessAn epidural abscess is a localized collection of purulent fluid between the dura mater and the overlying vertebral column (spinal epidural abscess) or skull (intracranial epidural abscess). 1,2Early diagnosis of epidural abscess is essential as without timely intervention neurologic injury with permanent sequelae can develop. 3 SPINAL EPIDURAL ABSCESS EpidemiologySpinal epidural abscess (SEA) is more common than intracranial epidural abscess and is increasing in incidence.In 1975 the reported incidence of SEA was 0.2-2 per 10,000 hospitalized patients.Over the past four decades this has risen to 10-12 per 10,000 hospitalized patients in some referral centers. [4][5][6] This increase is likely due to a rising number of patients with risk factors for SEA including intravenous drug use (IVDU), diabetes mellitus, advanced age, renal failure, and compromised immunity as well as degenerative spinal column disease and the growing use of therapeutic spinal interventions including instrumentation, injections, catheter placement and anesthetic procedures. 7,8The ongoing opioid epidemic in the United States has had a particular impact on the increased incidence of SEA given the risks of endovascular infection and metastatic seeding associated with intravenous drug use. 9The clinical utility of associated risk factors in the diagnosis of SEA in unclear, however, given their apparent absence in 20-50% of patients. 10Detection of SEA with the wide-spread availability of sensitive imaging modalities such as magnetic resonance imaging (MRI) has also improved diagnostic accuracy in recent decades.