Epidural abscess natural history, complications and prognosis

If left untreated, intracranial epidural abscess may cause headache, fever, and seizures. If left untreated, spinal epidural abscess may cause back pain, nerve root pain, and paralysis. Complications of epidural abscess include neurological deficits, meningitis, and sepsis. If treated timely, the prognosis for epidural abscess is generally good.

If left untreated, intracranial epidural abscess may cause headache, fever, and seizures. If left untreated, the condition will aggravate and severe complications will arise, possibly leading to a fatal outcome. Proper diagnosis and treatment are therefore necessary. Treatment usually involves aggressive antibiotic therapy and surgical drainage.

If left untreated, spinal epidural abscess may cause the following sequelae, which is classified into 4 stages:^[1][2][3][4]

1. Back and focal vertebral pain, with tenderness; fever; neurologic deficits
2. Nerve root pain, described as being “electric-shock” like, radiating from affected areas, sometimes accompanied by paresthesia
3. Dysfunction of the spinal cord, presenting by motor and sensory deficits and sphincter incompetence
4. Paralysis, which may quickly become irreversible

Complications from epidural abscess include:

• Neurological deficits
• Meningitis
• Sepsis
• Irreversible paralysis
• Sepsis
• Spinal cord injury
• Pressure sores
• Urinary tract infection
• Thrombophlebitis
• Pneumonia
• Thrombosis
• Thrombophlebitis of adjacent veins
• Ischemia
• Bacterial toxins
• Inflammatory response and its mediators

The rate of complications rises with the increase of time to reach the proper diagnosis and begin therapy.

If treated timely, the prognosis of epidural abscess is generally good. Full recovery is common among survivors and the mortality rate is low (<5%). Mortality is usually due to sepsis, prolonged immobility, or the development of meningitis.^[5] Positive outcomes are generally associated with:

• Presence of purulent material, instead of granulation tissue, indicating a more acute case
• Absence of paralysis or its presence for < 36 hours, indicating increased chances of returning to normal function

The most important factor to predict the final outcome is the patient’s neurological status prior to neurosurgery. The stages are:^[2]

Poor outcomes are generally associated with three factors:^[6]

• Age
• Degree of thecal sac compression
• Duration of symptoms