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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Epidural abscess differential diagnosis

Introduction

Overview

Overview

Intracranial epidural abscess must be differentiated from epidural hematoma, subdural empyema, brain abscess, tuberculous meningitis, and other intracranial mass lesions. Spinal epidural abscess must be differentiated from other conditions that cause back pain, weakness, and spinal tenderness, such as arthritis, osteoarthritis, intervertebral disc disease, vertebral osteomyelitis, primary or metastatic tumors, and musculoskeletal pain.

Differential Diagnosis

Differential Diagnosis

Intracranial Epidural Abscess

Intracranial epidural abscess must be differentiated from other diseases that cause headache, vomiting, fever, altered mental status, seizures, cranial nerve abnormalities, and paresis.[1] Intracranial epidural abscess must be differentiated from:

Disease Findings
Hematoma Presents with a collection of blood or bruise (if it occurs near the skin). If it occurs near the brain, it may act as a mass effect, and the patient may present with increased intracranial pressure, midline shift, and brain herniation.
Epidural hematoma Presents with a collection of blood in the epidural space, headache, back pain, confusion, weakness, and focal neurologic signs
Subdural empyema Presents with a collection of purulent material accumulating in the subdural space, mass effect, fever, headache, altered mental status, and seizures
Brain abscess Presents with a collection of purulent material within the brain tissue, confusion, decreased movement, decreased sensation, decreasing responsiveness, drowsiness, fever, headache, loss of coordination, nausea, seizure, and vomiting
Chronic meningitis Presents with inflammation of the meninges, headache, nuchal rigidity, fever, and altered mental status
Tuberculous meningitis Presents with inflammation of the meninges, fever, headache, confusion, and focal neurologic signs
Tumor, including primary parenchymal, metastatic, and meningioma Presents with an intracranial tumor, focal neurologic signs, increased intracranial pressure, and seizures
Temporal arteritis Presents with inflammation of the blood vessels of the head, commonly the large and medium arteries, fever, headache, and focal neurologic signs

Spinal Epidural Abscess

Spinal epidural abscess must be differentiated from other diseases that cause back pain, fever, weakness, and spinal tenderness.[2][3][4][5] Therefore, spinal epidural abscess must be differentiated from:

Disease Findings
Musculoskeletal pain Presents with lower back pain following overuse and over stretching of muscles, or in the context of a viral infection
Arthritis and Osteoarthritis Presents with back pain, stiffness, tenderness, and weakness
Degenerative disc disease Presents with lower back pain, tenderness, and weakness
Spinal disc herniation Presents with the soft central nucleus pulposus bulging out, lower back pain, leg pain, tingling, numbness, and reflex changes
Shingles Presents with painful skin rash, blisters, fever, headache, chills, and tingling sensations
Spinal cord ischemia Presents with radiculopathy, weakness and pain
Vertebral osteomyelitis Presents with infected bone and bone marrow, fever, back pain, swelling, weakness of the vertebral column and surrounding muscles, and night sweats
Leukemia Presents with bruises, dyspnea, fever, chills, weakness, fatigue, headache, and bone and joint pain
Epidural hematoma Presents with a collection of blood in the epidural space, headache, back pain, confusion, weakness, and focal neurologic signs
Chronic meningitis Presents with inflammation of the meninges, headache, nuchal rigidity, fever, and altered mental status
Tumor Presents with focal neurologic signs, increased intracranial pressure, lower back pain, and seizures
References

References

  1. ↑ Fountas KN, Duwayri Y, Kapsalaki E, Dimopoulos VG, Johnston KW, Peppard SB; et al. (2004). “Epidural intracranial abscess as a complication of frontal sinusitis: case report and review of the literature”. South Med J. 97 (3): 279–82, quiz 283. PMID 15043336.
  2. ↑ Grewal, S. (2006). “Epidural abscesses”. British Journal of Anaesthesia. 96 (3): 292–302. doi:10.1093/bja/ael006. ISSN 0007-0912.
  3. ↑ Maslen DR, Jones SR, Crislip MA, Bracis R, Dworkin RJ, Flemming JE (1993). “Spinal epidural abscess. Optimizing patient care”. Arch Intern Med. 153 (14): 1713–21. PMID 8333809.
  4. ↑ Ngan Kee WD, Jones MR, Thomas P, Worth RJ (1992). “Extradural abscess complicating extradural anaesthesia for caesarean section”. Br J Anaesth. 69 (6): 647–52. PMID 1467114.
  5. ↑ Keon-Cohen BT (1968). “Epidural abscess simulating disc hernia”. J Bone Joint Surg Br. 50 (1): 128–30. PMID 5641580.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]; Anthony Gallo, B.S. [3]