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  • Updated 02.28.2024
  • Released 07.26.1995
  • Expires For CME 02.28.2027

Intracranial epidural abscess



Intracranial epidural abscess is a potentially life-threatening complication of pericranial infection, particularly sinusitis and, less frequently, otitis. The condition may also develop after cranial trauma or neurosurgical procedures. The intracranial epidural abscess is often accompanied by osteomyelitis of the frontal bone with associated subperiosteal abscess (Pott’s puffy tumor), but it may also present without localizing symptoms or signs. Intracranial epidural abscess itself is rarely fatal but may progress to much more serious conditions, including intracranial subdural empyema, meningitis, brain abscess, or venous sinus thrombosis. In this article, the author discusses the pathogenesis and clinical presentation of intracranial epidural abscess and provides an approach diagnosing and treating the disorder.

Key points

• Intracranial epidural abscess represents loculated infection between the skull and the outermost layer of the cranial meninges, the dura mater.

• The condition is usually a complication of frontal sinusitis. Less frequently, the condition may occur as a complication of otitis, mastoiditis, craniofacial trauma, or neurosurgical procedures.

• Symptoms of epidural abscess are fever, focal pain, and, at times, subcutaneous swelling over the affected area, indicating a subperiosteal abscess (Pott’s puffy tumor).

• The condition is important in its own right but may also spread inward to cause much more dangerous conditions, including intracranial subdural empyema, meningitis, brain abscess, or septic venous thrombophlebitis.

• Diagnosis may be made by MRI or, less optimally, CT. Treatment involves antibiotics and often requires surgical drainage.

Historical note and terminology

Epidural abscess represents infection between the outermost layer of the meninges (the dura) and the overlying skull. Focal osteomyelitis (following cranial trauma, with separation of the frontal bone from the underlying dura) was described in 1771 by Percival Pott. The literature concerning cranial epidural abscess, however, is comprised for the most part of individual case reports over much of the past century (51; 73; 46; 32; 33). Intracranial epidural abscess was initially a condition diagnosed by burr holes and subsequently (with varying degrees of accuracy) by radionuclide imaging or angiography (46; 60). CT provided the first noninvasive method of detecting intracranial epidural abscess (44). However, MRI has provided a more precise technique for imaging intracranial infection and has demonstrated its ability to identify infections not yet visible by CT (77; 86; 59). Improved imaging techniques have made it apparent that certain early epidural infections in neurologically stable patients may be treated with antibiotics alone.

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