An epidural abscess is collection of pus (infected material) between the outer covering of the brain and spinal cord and the bones of the skull or spine. The abscess causes swelling in the area.

Epidural abscess is a rare disorder caused by infection in the area between the bones of the skull or spine, and the membranes covering the brain and spinal cord (meninges). This infection is called an intracranial epidural abscess if it is inside the skull area, or a spinal epidural abscess if it is found in the spine area. Nine out of 10 cases are located in the spine.

The infection is usually caused by bacteria (staphylococcus aureus is common), but may be caused by fungus. It can be due to other infections in the body, or germs that spread through the blood. However, in up to one-third of patients, no source of infection is found.

In the case of an intracranial epidural abscess (within the skull), risk factors include:

• Chronic ear infections
• Chronic sinusitis
• Head injury
• Mastoiditis
• Recent neurosurgery

A spinal epidural abscess may be seen in patients with:

• A history of back surgery or other invasive procedures involving the spine
• Bloodstream infections
• Boils
• Bone infections of the spine (vertebral osteomyelitis)

People who inject drugs are also at increased risk.

Spinal epidural abscess:

• Bowel or bladder incontinence
• Difficulty urinating (urinary retention)
• Fever and back pain

Intracranial epidural abscess:

• Fever
• Headache
• Lethargy
• Nausea and vomiting
• Pain at the site of recent surgery that gets worse (especially if fever is present)

Neurological symptoms depend on the location of the abscess and may include:

• Decreased ability to move any part of the body
• Loss of sensation in any area of the body, or abnormal changes in sensation
• Paralysis
• Weakness

The health care provider will perform an exam to look for a loss of functions such as movement or sensation.

Tests may include:

• CT scan
• MRI
• Sample of the abscess to determine what is causing the infection

The goal of treatment is to cure the infection and reduce the risk of permanent damage. Treatment usually includes antibiotics and surgery. In rare cases, antibiotics alone are used.

Antibiotics are usually given through a vein (IV) for at least 4-6 weeks. However, some people may need to take them for a longer time, depending on the type of bacteria and severity of the disease.

Surgery is usually needed to drain or remove the abscess. In addition, surgery is often needed to reduce pressure on the spinal cord or brain, to prevent further loss of function.

Early diagnosis and treatment greatly improve the chance of a good outcome. Once weakness, paralysis, or sensation changes occur, the chances of recovering lost function are reduced. Permanent nervous system damage or death may occur.

• Brain abscess
• Chronic back pain
• Meningitis
• Permanent brain and nervous system damage (such as brain damage, sensory changes, or paralysis) if diagnosis and treatment are delayed
• Return of infection (common even if the disorder is treated)
• Spinal cord abscess
• Spread of infection into the bones of the spine or skull (osteomyelitis)

Call your health care provider if you have:

• Persistent back pain with fever
• Headache with fever
• Other symptoms of epidural abscess

An epidural abscess is a medical emergency.

Treatment of certain infections, such as ear infections, sinusitis, and bloodstream infections, may decrease the risk of an epidural abscess. Early diagnosis and treatment are essential to prevent complications.

Nath A. Brain abscess and parameningeal infections. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 438.