Epidural Abscess

An epidural abscess is a rare infection where a collection of pus is in your epidural space. This space is between the protective covering of your brain and spinal cord (dura mater), and the bones that make up your skull and spine.

Since the epidural space contains blood vessels and nerve endings, an infection can cause severe pain. It also affects how your nervous system functions.

An epidural abscess is a medical emergency. It can be fatal if not treated quickly, or it can lead to permanent damage to your body.

Types of epidural abscesses

There are two types of epidural abscesses based on the infection’s location:

• Spinal epidural abscess: The infection happens in your spine.
• Intracranial epidural abscess: The infection happens inside your skull.

Spinal epidural abscesses are more common than intracranial abscesses.

Spinal epidural abscess symptoms

Symptoms of a spinal epidural abscess may include:

• Back pain (often severe)
• Fever and chills
• Lethargy
• Nausea and vomiting
• Swelling and tenderness near the abscess

If you have a spinal epidural abscess, it may press against your spinal cord. This might cause neurological symptoms, including:

• Difficulty walking
• Leg weakness or paralysis
• Loss of bowel or bladder control
• Loss of feeling in your butt, legs and genital area

The infection can spread to nearby muscles and cause pain with leg movement.

If you notice any of these symptoms, contact a healthcare provider right away. Symptoms may get worse within hours to days after the infection starts.

Intracranial epidural abscess symptoms

Symptoms of an intracranial epidural abscess may include:

• Drainage from the nose
• Double vision
• Drowsiness or lethargy
• Facial swelling
• Fever
• Headaches
• Light sensitivity
• Nausea and vomiting

Epidural abscess causes

Bacteria cause epidural abscess infections. Sometimes, fungi and parasites cause it, too. The abscess forms when infected material (pus) collects in a pocket in the epidural space. This causes swelling in your spine or skull.

Causes vary based on the type of epidural abscess you have.

A spinal epidural abscess may happen after:

• An infection that started elsewhere in your body spread through your bloodstream (like endocarditis)
• Boils
• Bone infection (osteomyelitis)
• Spine surgery

An intracranial epidural abscess may happen after:

• Brain surgery
• Frequent ear infections
• Mastoiditis
• Sinusitis
• Traumatic brain injury

In some cases, a cause isn’t known. Regardless, providers can still treat the abscess to prevent complications.

Epidural abscess risk factors

You may be more at risk of an epidural abscess if you have one of the following:

• A condition or long-term use of a medication that suppresses your immune system
• Alcohol use disorder
• Diabetes
• Kidney failure
• Substance use disorder (substance injections into your veins)

Epidural abscess complications

Epidural abscess complications can be life-threatening or cause permanent damage. While rare, they include:

• Brain damage
• Chronic back pain
• Nerve damage
• Paralysis
• Spinal cord compression
• Spine fractures
• Septic thrombophlebitis causing tissue death (necrosis)

How doctors diagnose an epidural abscess

Your provider will diagnose an epidural abscess after a physical exam and testing. They’ll take your temperature to see if you have a fever. While learning more about your medical history, your provider may ask if you had a recent infection, surgery or procedure.

An MRI can confirm the diagnosis. During this imaging test, your provider will find the exact location of the abscess in your body. Your provider may also take a culture sample of the infected area (if possible) or offer a blood test to determine the cause of the infection.

How is an epidural abscess treated?

Antibiotics usually treat an epidural abscess caused by a bacterial infection. Antifungals and antiparasitics treat fungal and parasitic infections.

Severe cases, where the abscess compresses your brain or spinal cord, may need emergency drainage surgery to prevent complications. Your surgeon will send a sample of the infected fluid to a lab to verify the cause of the infection. Your care team may give you antibiotics before the procedure. When the culture results return, they may change the type of medication they give you to get rid of the infection.

Epidural abscess recovery

You may need to take antibiotics for four to six weeks or more to completely remove the infection from your body. You should continue taking your course of antibiotics, even if you feel better, until you use up all of your medication. This will ensure that your body and the antibiotics have enough time to clear the infection completely.

Eating healthy and treating other health problems can help your body fight the infection and stop it from coming back

If you needed a drainage procedure or surgery, your provider will give you instructions on how to care for yourself. You may need to stay in the hospital for a couple days or weeks, depending on how serious your condition is. Your doctor will want to make sure there are no lasting problems.

When should I see my healthcare provider?

Call your provider if you have symptoms of an epidural abscess. Visit the emergency room if you notice symptoms like unusual leg weakness or a sudden loss of feeling in part of your body.

Contact your provider immediately if you develop new or worsening symptoms after treatment for an abscess. Though uncommon, these infections can come back and require more treatment.

What is the prognosis for an epidural abscess?

Many people have a good outlook and survival rate when they receive treatment shortly after symptoms start. Antibiotics and draining the abscess can get you on track to feeling better. The infection may come back if it wasn’t removed entirely. This is why it’s important to follow your provider’s instructions and take your antibiotics as directed.

While complications are rare, they’re possible. It can significantly impact how well your nervous system works or be fatal, in some cases. If you notice symptoms, especially with a fever, contact a healthcare provider as soon as possible.