Abscesses confined to epidural spaces are usually associated with infection of overlying cranial bone. Etiologies include:
- sinusitis (most common)
- head trauma
- neurosurgical complication
Infection spreads to produce subdural and intraparenchymal abscesses, and meningitis can occur. Clinical manifestations, in addition to headache and fever, are generally referable to the abscess’s mass effect, including increased intracranial pressure and seizures.
Neuroimaging usually reveals an extradural collection. Lumbar puncture is risky because of increased intracranial pressure, and CSF analysis is usually nonspecific anyway (mildly elevated protein, mild pleocytosis, with negative Gram’s stain and cultures).
Antibiotic therapy is targeted to the likely infectious source (e.g., sinusitis). Surgical evacuation is usually necessary. Seizure management is routine. Maintenance anticonvulsant therapy after successful abscess cure usually is not required.180
Adapted from: Goldstein MA and Harden CL. Infectious states. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;83-133.
With permission from Elsevier (www.elsevier.com).