Intracranial epidural abscess

Historical note and nomenclature
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By John E Greenlee MD

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 contained for the most part in individual case reports over much of the past century (Leopold 1916; Skillern 1922; Koenig and Craigmile 1956; Handel et al 1974; Harris et al 1987). Intracranial epidural abscess was initially a condition diagnosed by burr holes and subsequently (with varying degrees of accuracy) by radionuclide imaging or angiography (Koenig and Craigmile 1956; Norrell and Wilson 1967). CT provided the first noninvasive method of detecting intracranial epidural abscess (Kaufman and Leeds 1977). 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 (Sze and Zimmerman 1988; Younis et al 2002). Improved imaging techniques have made it apparent that certain early epidural infections in neurologically stable patients may be treated with antibiotics alone.