Epidural abscess

Alternative names:

abscess - epidural

Treatment:

The goal of treatment is to cure the infection and reduce the risk of permanent neurologic damage.

Antimicrobial medications are given. They are initially given intravenously (in a vein) and later may be changed to oral medications. Antimicrobial treatment may be prolonged over 1 or 2 months. Antibiotics, particularly broad-spectrum antibiotics, are the most common antimicrobial prescribed. Antifungal or antiviral medications may be needed if there is a significant risk for fungal or viral infection.

Corticosteroids may occasionally be prescribed to reduce swelling and pressure on the spinal cord or brain.

Surgery is usually eminently necessary because the lining (membrane) that encloses the abscess may prevent the antimicrobial medications from reaching the microorganism. It may also be indicated to reduce pressure on the spinal cord or brain. Surgery may include drainage of the abscess or removal (excision) if the abscess is localized and can be removed intact. Surgical drainage of the original infection site may be necessary if epidural abscess develops secondary to infection elsewhere in the body.

Expectations (prognosis):

Untreated, the prognosis (probable outcome) includes early death or severe, permanent neurologic losses. Recovery is the expected prognosis (probable outcome) for treated abscess. If treated early, recovery is usually complete. Various neurologic losses may persist if treatment is delayed.

Complications:

• recurrence of infection (common even if the disorder is treated)
• spread of infection
• cerebral abscess
• spinal cord abscess
• meningitis
• permanent neurologic losses (uncommon if the disorder is treated)
  • such as decreases in movement, sensation, speech, or vision
  • vary with amount of disability

Calling your health care provider:

Call your health care provider if fever, persistent headache, back pain, or other symptoms of epidural abscess develop, particularly if there is a known risk for the disorder (such as chronic infection).

Consult the health care provider promptly. An epidural abscess is an urgent condition. Early diagnosis and treatment greatly improve the chance of a good outcome. Once neurologic symptoms occur (such as weakness, paralysis, sensation changes, and seizures) they tend to be severe and rapidly progressive.

Go to the emergency room or call the local emergency number (such as 911) if seizures, progressive speech or other sensory difficulty, progressive loss of movement, or progressive loss of sensation occur.