Intracranial epidural abscess

Intracranial epidural abscess is a serious infection which constitutes a recognised neurosurgical emergency. Most commonly it is caused by spread of infection from the para-nasal sinuses, middle ear or mastoid. Post-craniotomy infection or compound skull fractures can result in an osteomyelitis and hence lead to the formation of an epidural collection. The abscess cavity is often too small to produce clinical evidence of impaired cerebral function. However, if not diagnosed and treated early enough, serious intracranial complications may arise. We report a case of epidural abscess presenting with raised intracranial pressure, and stress the value of CT scanning in the early diagnosis and in the follow-up of such cases. A 13-year-old schoolboy presented with two weeks' history of a tender fluctuating swelling overlying the centre of his forehead. Two months earlier he had complained of throbbing headache on physical activity, felt unwell, and suffered head colds with complicating sinusitis. Because of the presence of facial swelling his G.P. treated him with antihistamines. This swelling appeared gradually over a period of two weeks. Three days prior to admission the facial swelling became tense and the eyelids almost closed. On physical examination he was obtunded, pale but apyrexial. A mid-line swelling overlay the forehead and extended some 5 cm posterior to the coronal suture. It was moderately tender and fluctuant. The skin of the overlying scalp however, appeared normal.