Intracranial Epidural Abscess Research Articles

Intracranial epidural abscess secondary to medication‐related osteonecrosis of the jaw: A case report

Intracranial epidural abscess secondary to medication‐related osteonecrosis of the jaw: A case report

Diagnostic role of sonography in early detection and surgical intervention of an epidural abscess: A case report

AbstractIntroductionIntracranial epidural abscesses require swift diagnosis and treatment. While magnetic resonance imaging (MRI) is preferred for its detailed visualisation, it is costly and time‐consuming. Transcranial sonography offers a rapid, portable and cost‐effective alternative for assessing brain lesions.MethodsWe present a case study involving the diagnosis and management of an intracranial epidural abscess in a 25‐year‐old man with a traumatic brain injury who underwent a craniectomy and later developed fever and drowsiness in the intensive care unit.ResultsUsing transcranial point‐of‐care ultrasound, a hypoechoic collection was identified at the surgical site, prompting further imaging with computed tomography (CT) and MRI, which confirmed the diagnosis of an epidural abscess. Prompt surgical intervention led to the resolution of symptoms and a favourable clinical outcome.ConclusionThis case highlights the potential utility of brain sonography as an efficient and cost‐effective initial diagnostic tool for detecting intracranial complications, particularly in postoperative patients with altered sensorium and fever, where timely intervention is crucial.

Odontogenic Intracranial Epidural Abscess: report of two cases and review of literature

Odontogenic Intracranial Epidural Abscess: report of two cases and review of literature

Periorbital necrotizing fasciitis accompanied by sinusitis and intracranial epidural abscess in an immunocompetent patient.

Periorbital necrotizing fasciitis accompanied by sinusitis and intracranial epidural abscess in an immunocompetent patient.

Paediatric bacterial meningitis in the USA: outcomes and healthcare resource utilization of nosocomial versus community-acquired infection.

Introduction. Paediatric bacterial meningitis remains a costly disease, both financially and clinically.Hypothesis/Gap Statement. Previous epidemiological and cost studies of bacterial meningitis (BM) have largely focused on adult populations or single pathogens. There have been few recent, large-scale studies of pediatric BM in the USA.Aim. We examined healthcare resource utilization (HCRU) and associated morbidity and mortality of community-acquired versus nosocomial bacterial infections in children across the USA.Methodology. The IBM MarketScan Research databases were used to identify patients <18 years old admitted to USA hospitals from 2008 to 2015 with a primary diagnosis of BM. Cases were categorized as either community-acquired or nosocomial. HCRU, post-diagnosis neurosurgical procedures, 30-day in-hospital mortality, and complications were compared between groups. Multivariable regression adjusted for sex, age and Gram staining was used to compare costs of nosocomial versus community-acquired infections over time.Results. We identified 1928 cases of paediatric BM without prior head trauma or neurological/systemic complications. Of these, 15.4 % were nosocomial and 84.6 % were community-acquired infections. After diagnostic lumbar puncture (37.1 %), the most common neurosurgical procedure was placement of ventricular catheter (12.6 %). The 30-day complication rates for nosocomial and community-acquired infections were 40.5 and 45.9 %, respectively. The most common complications were hydrocephalus (20.8 %), intracranial abscess (8.8 %) and cerebral oedema (8.1 %). The 30-day in-hospital mortality rates for nosocomial and community-acquired infections were 2.7 and 2.8 %, respectively.Median length of admission was 14.0 days (Q1: 7 days, Q3: 26 days). Median 90-day cost was $40 861 (Q1: $11 988, Q3: $114,499) for the nosocomial group and $56 569 (Q1: $26 127, Q3: $142 780) for the community-acquired group. In multivariable regression, the 90-day post-diagnosis total costs were comparable between groups (cost ratio: 0.89; 95 % CI: 0.70 to 1.13), but at 2 years post-diagnosis, the nosocomial group was associated with 137 % higher costs (CR: 2.37, 95 % CI: 1.51 to 3.70).Conclusion. In multivariable analysis, nosocomial infections were associated with significantly higher long-term costs up to 2 years post-infection. Hydrocephalus, intracranial epidural abscess and cerebral oedema were the most common complications, and lumbar punctures and ventricular catheter placement were the most common neurosurgical procedures. This study represents the first nation-wide, longitudinal comparison of the outcomes and considerable HCRU of nosocomial versus community-acquired paediatric BM, including characterization of complications and procedures contributing to the high costs of these infections.

Cerebral Epidural Abscess Secondary to Blastomyces Masquerading as an Epidermoid Tumor.

There have been infrequent reports of isolated central nervous system blastomycosis. We report a case of intracranial epidural abscess secondary to Blastomyces dermatitidis in a patient residing in Rhode Island with a history of remote travel to an endemic area. The clinical, radiographic, and pathologic features of this unique case are reviewed.

ENGLISH

A previously healthy seven-year-old girl, who suffered a minor head injury, experienced diagnostic complications spanning two weeks, resulting from an intracranial epidural abscess. Originally diagnosed with cephalgia and a urinary tract infection, which were unresponsive to antibiotics, secondary workup revealed a large bifrontal epidural lesion. She was transferred to our neurosurgery services for further management and workup of the lesion. Magnetic resonance imaging demonstrated an enhancing anterior parasagittal fluid collection that was suggestive of an infection. Burr-hole surgery directly over the lesion confirmed the diagnosis of brain abscess. Irrigation and drainage was done, and her recovery was rapid and uncomplicated with the subsequent treatment with appropriate antibiotics. A possible etiology for this unusually located abscess is that the patient had a hemorrhage into this location from the initial injury. This subsequently became infected after a urinary tract infection or sinusitis. This case may be a useful reference for identifying patients with a brain abscess after a minor head injury, this occurring without direct invasion of the region of concern with a known foreign body, the usual mechanism after a traumatic brain injury.

Twelve-year-old girl with intracranial epidural abscess and sphenoiditis

We report the case of a 12-year-old girl with an intracranial epidural abscess and sphenoiditis. Although she had no history of sinusitis, she developed acute severe headache, fever, and vomiting. Emergent CT and MRI showed a spherical space-occupying lesion of diameter 3cm in the right cranial fossa with rim enhancement. The lesion was thought to be an epidural abscess adjacent to the right sphenoiditis. On the basis of the MRI findings, we performed emergent surgery to drain the abscess and sinusitis because of severe and rapidly worsening headaches. The patient showed great improvement the day after the operation. Intravenous antibiotics were administered for 8days. She has completely recovered, with neither sequelae nor recurrence at 7months after the operation. We believe that this report will be a useful reference for cases of acute onset headache and may be helpful in diagnosis and treatment decisions for severe sinusitis-related intracranial abscess in childhood.

Chronic sinus disease and epidural abscess: Gemella morbillorum as emerging cause of central nervous system infections

Dear Editor, There is emerging evidence of Gemella morbillorum (GM) as a pathogen capable of causing potentially lifethreatening central nervous system (CNS) infections. We document the first case of intracranial epidural abscess (EA) caused by this pathogen, and emphasize the need to consider potential neurological involvement in patients with chronic sinus disease from whom GM is isolated. A 14-year-old boy presented with a 2-week history of headache and fever. His past medical history was only significant for sinusitis 2 years earlier. He was initially treated in the community for acute sinusitis by the family physician. Upon admission, he appeared mildly distressed, with a body temperature of 38.5 °C, complained of frontal headache, and vomited twice during clinical examination. Neurological examination was unremarkable, and blood investigations documented a CRP of 260 mg/l and an ESR of 99 mm/h. He was therefore empirically administered a large-spectrum antibiotic therapy. Over the following day, he remained pyrexial and his headache and vomiting worsened: a CT head scan showed frontal and left-sided maxillary and ethmoidal sinuses opacification, with extensive epidural frontal collection. A contrast-enhanced MRI scan revealed frontal epidural empyema and superior sagittal sinus compression with no evidence of dural sinuses thrombosis (Fig. 1, top). The patient underwent an urgent frontobasal bilateral craniotomy. A bicoronal flap was raised and an initial burr hole was placed in the frontal parasagittal area, yielding copious purulent debris under pressure. After craniotomy was performed, a purulent collection extending from the frontal sinuses up to the coronaric suture was noted. The frontal sinuses were opened and drained, with subsequent cranialization and closure with a galeal flap. The post-operative course was uneventful and our patient has remained apyrexial ever since the operation, with normalization of inflammatory markers. Intraoperative cultures from purulent material grew a metronidazole-resistant strain of Gemella morbillorum. He received a total of 14 days of intravenous antibiotics and was discharged on the 15th postoperative day, in good clinical condition. Gammainterferon and IL-12 serum levels were normal. A contrastenhanced MRI head scan carried out 3 months after surgery was unremarkable (Fig. 1, bottom).

Intracranial epidural abscess of odontogenic origin

Dental infection as a cause of epidural abscess is rare compared with other forms of intracranial suppurations. A 10-year-old boy was seen because of headaches and fever. There was no history of otitis media or sinusitis, but he had sought care for dental complaints. The patient was from an upper-middle-class family, was not immunocompromised, and had no other risk factor for a major infection. A CT brain scan confirmed a frontal epidural abscess. The patient underwent emergency surgery for evacuation of the epidural abscess, followed by antimicrobial therapy. His condition improved remarkably following surgery, with complete resolution of symptoms. He subsequently underwent extraction of 2 teeth following dental review. Dental infection as a cause of intracranial epidural abscess is rare, but should be considered when evaluating patients for intracranial infections. A review of the literature sheds light on the causal relationship and possible pathogenesis of this condition.

Recurrent Pott's puffy tumor – atypical presentation of a rare disorder

We report the case of a 14-year-old girl who presented with an 8-week history of unilateral pansinusitis. In the course of the disease a right-side frontal swelling was observed, which disappeared following antibiotic treatment. Four weeks later, however, the swelling reappeared and was now diagnosed as recurrent Pott's puffy tumor. Interestingly, C-reactive protein levels were in the normal range throughout. Following functional endoscopic frontal sinusotomy, antibiotic treatment with ceftriaxone was administered over 3 weeks and led to complete remission of the lesion. Pott's puffy tumor is a subperiostal abscess of the frontal bone, usually presenting as localized swelling of the soft tissue in the overlying region of the forehead, and is associated with localized osteomyelitis and occasionally with intracranial epidural abscess. The entity has been known since 1768, although recurrent cases with normal inflammation parameters have not been published previously.

Spinal and Intracranial Epidural Abscess

Presentation, epidemiology, diagnosis and treatment of spinal epidural abscess (SEA) and intracranial epidural abscess (ICEA) are reviewed by researchers at The John's Hopkins University School of Medicine, Baltimore, MD, and Universidad de Santander, Columbia.

Epidural abscesses of the CNS

Epidural abcessess can involve the intercranial or spinal compartments and can result in potentially devastating neurological injuries. Although rare, incidence of spinal epidural abscesses (SEAs) is increasing as predisposing factors such as injected-drug use, chronic immunosuppression, and spinal surgery become more common. Whereas symptoms of SEAs can include fever, back pain, and neurological dysfunction, the presentation of intracranial epidural abscesses (ICEAs) is less well defined. Neuroimaging narrows the potential diagnoses and enables prompt empirical therapy until specific microbiological diagnosis is made. Surgical intervention is an integral part of treatment for epidural abscesses in patients with neurological symptoms or who have not responded to medical management. Prognosis for both SEAs and ICEAs is typically poor because of delayed diagnosis and intervention and is dependent on the neurological status at the time of diagnosis. Increased clinical awareness can greatly improve outcomes by helping to diagnose patients earlier.

Successful Sonographically Guided Drainage of Epidural Abscess

WEB This is a Web exclusive article. pidural abscesses are most commonly found in the older pediatric age group (12–16 years) and adults; they are relatively rare in younger children [1]. Epidural abscesses are almost always secondary to or associated with other infections such as mastoiditis, sinusitis, postoperative infection, osteomyelitis of the skull, or complications of trauma or surgery [2, 3]. Traditional management of epidural abscesses in children involves neurosurgical drainage and antibiotic therapy [3, 4]. Techniques for neurosurgical drainage include evacuation of the epidural collection through a burr hole or a craniotomy [3]. Given the availability of more powerful antibiotics, the trend toward using less invasive alternatives for evacuation of epidural abscesses [3] has grown. In that light, we report on the percutaneous drainage of an intracranial epidural abscess using sonography guidance in a 15year-old boy.

Conservative Neurosurgical Management of Intracranial Epidural Abscesses in Children: In Reply

Conservative Neurosurgical Management of Intracranial Epidural Abscesses in Children: In Reply

Conservative Neurosurgical Management of Intracranial Epidural Abscesses in Children

Neurosurgery: July 2004 - Volume 55 - Issue 1 - p 263-264 doi: 10.1227/01.neu.0000440737.74380.3f

Conservative neurosurgical management of intracranial epidural abscesses in children.

Traditional management of epidural abscesses caused by sinusitis in children involves neurosurgical drainage. With better techniques to drain affected sinuses, to identify causative organisms, and to guide medical therapy, some pediatric epidural intracranial abscesses may be treated effectively with sinus drainage and antibiotics, without an intracranial procedure. Charts and computed tomographic scans of children with isolated intracranial epidural abscess associated with sinusitis who were treated in a pediatric hospital were reviewed retrospectively. Eight patients were treated between 1982 and 2002. All patients received antibiotic therapy appropriate to the causative organism(s). Four patients treated before mid-1997 had an intracranial procedure additionally (operative group, Group 1), and four patients treated thereafter did not (conservative group, Group 2). Abscesses had a mean size of 3 x 3 x 1 cm (length x width x depth) in both groups. All patients experienced clinical and radiographic resolution of the infection with treatment. In Group 1, neurosurgical management consisted of burr hole drainage in two patients and craniotomy in two patients. Extranasal otorhinolaryngological procedures for sinus drainage were performed in two patients. In Group 2, endonasal procedures were used in three patients for paranasal sinus infections to effect drainage and obtain specimens for culture. A radical mastoidectomy was required in the single patient with mastoiditis. Although two of four patients initially demonstrated transient worsening of headaches, all patients subsequently improved rapidly after the first week of treatment. Computed tomographic follow-up revealed minimal or no enlargement of the abscess or mass effect at 1 week, decrease or stable size at 2 weeks, and resolution by 6 weeks. Sinus-related intracranial epidural abscesses in children may be managed without neurosurgical procedures in the setting of adequate sinus drainage, appropriate antibiotic therapy, and minimal extradural mass effect from the abscess. Symptomatic worsening without significant increase in mass effect during the first week of therapy is not necessarily an indication for an intracranial drainage procedure.

Absceso epidural intracraneal en neonato secundario a catéter cutáneo

Intracranial epidural abscesses are uncommon lesions, being more frequents in older children and adults. They commonly arise as a result of direct extension of a preexisting infection and rarely present with focal deficit. We present a case of a 11-days old preterm infant who developed an intracranial epidural abscess as a result of an infected scalp vein catheter. The diagnosis was made on the basis of the cranial ultrasound and CT scan images. An identified strain of Enterococcus faecium was cultured from all the samples. The patient underwent a right frontal craniotomy with drainage of the abscess and a 2-week total course of intravenous antibiotics was administrated. CT scan imaging 3 week after the procedure demonstrated no evidence of residual lesion. When present, a scalp vein catheter, in absence of others predisponing factors, must be considered as an etiologic agent for an intracranial epidural abscess in this age-group.

Brain Abscess, Subdural Empyema, and Intracranial Epidural Abscess.

Brain abscess, subdural empyema, and intracranial epidural abscess are three of the most commonly encountered focal suppurative processes of the central nervous system. A great deal has been known about the epidemiology and pathogenesis of these entities for quite some time, but until recent years the associated morbidity and mortality remained very high. New imaging techniques have allowed for more rapid detection and more precise localization of these lesions for surgical drainage. Empiric antimicrobial regimens that are effective within the abscess environment and that are directed against the most likely pathogens have also contributed to the improved outcomes seen in the current literature. This article will discuss some of the more recent advances in the diagnosis and treatment of these suppurative lesions within the central nervous system.

慢性副鼻腔炎に合併した眼窩内および頭蓋内硬膜外膿瘍の1治験例

近年稀となった副鼻腔炎に起因する頭蓋内感染症, 特に硬膜外膿瘍の1例の外科的根治例を報告した.症例は18歳の男性で, 学童期よりしばしば感冒に伴い副鼻腔炎を併発していた.今回左眼瞼発赤腫脹, 発熱, 頭痛で発症し, CT上眼窩内および硬膜外膿瘍を認めた.術前より広域スペクトラム抗生物質の投与を行い, ついで穿頭膿瘍ドレナージでは根治性に問題があると判断し, 開頭硬膜外膿瘍除去, 前頭洞内粘膜郭清, 外減圧術を施行し, 同時に眼窩内膿瘍ドレナージ術も行った.前頭洞内の処理については, 感染の再燃を考慮し, 前頭洞から前篩骨洞への内ドレナージを行った.術後起因菌同定後感受性抗生物質を投与し緩解した.