Intracranial epidural abscess

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By John E Greenlee MD

Intracranial epidural abscess is also known as or subsumes Epidural empyema and Pachymeningitis externa. -ed.

Intracranial epidural abscess is a potentially life-threatening complication of pericranial infection, particularly sinusitis. The condition may also develop after cranial trauma or neurosurgical procedures. Although the condition may be accompanied by cellulitis (Pott puffy tumor) and by osteomyelitis of the overlying skull, 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 clinical article, Dr. John Greenlee, Professor of Neurology at University of Utah School of Medicine and staff neurologist at the George E Wahlen Veterans Affairs Medical Center in Salt Lake City, Utah, discusses the pathogenesis and clinical presentation of intracranial epidural abscess and provides an approach to diagnosis and treatment of 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 almost always a complication of frontal sinusitis. Less frequently, the condition may occur as a complication of otitis or mastoiditis.
  • Symptoms of epidural abscess are fever, focal pain, and, at times, subcutaneous swelling over the affected area (Pott 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.