Diferencia entre revisiones de «Epidural abscess (intracranial)»
(→DDX) |
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| Línea 26: | Línea 26: | ||
*Surgical decompresion | *Surgical decompresion | ||
*Antibiotics | *Antibiotics | ||
**Vanco + metronidazole + | **[[Vanco]] + [[metronidazole]] + ([[cefotaxime]] or [[ceftriaxone]] or [[ceftazidime]]) | ||
*** | ***[[Ceftazidime]] is preferred if [[pseudomonas]] is considered likely | ||
***Can substitute nafcillin or oxacillin for vanco if not MRSA | ***Can substitute [[nafcillin]] or [[oxacillin]] for [[vanco]] if not [[MRSA]] | ||
**Treat for 6-8 weeks | **Treat for 6-8 weeks | ||
**If likely nasopharyngeal source (sinusitis, mastoiditis), may consider regiment covering strep, | **If likely nasopharyngeal source ([[sinusitis]], [[mastoiditis]]), may consider regiment covering [[strep]], [[Haemophilus influenzae]], and [[aerobes]] | ||
==See Also== | ==See Also== | ||
Revisión del 18:08 9 feb 2015
Background
- Much less common than spinal epidural abscess (1:9)
- Usually caused by local spread of infection or local inoculation during surgery or trauma
- Usually isolated to calvarium due to adherence of dura to foramen magnum
Clinical Features
- Symptoms of intracranial mass
- papilledema
- focal neurologic symptoms
- Headache
- Vomiting/nausea
Diagnosis
- Suspect diagnosis based on clinical history and physical exam
- Imaging modality of choice is MRI
- CT w/ IV contrast is reasonable alternative
Differential Diagnosis
- Any intracranial mass
- ICH
- Tumor
- Brain abscess
- Subdural empyema
Treatment
- Surgical decompresion
- Antibiotics
- Vanco + metronidazole + (cefotaxime or ceftriaxone or ceftazidime)
- Ceftazidime is preferred if pseudomonas is considered likely
- Can substitute nafcillin or oxacillin for vanco if not MRSA
- Treat for 6-8 weeks
- If likely nasopharyngeal source (sinusitis, mastoiditis), may consider regiment covering strep, Haemophilus influenzae, and aerobes
- Vanco + metronidazole + (cefotaxime or ceftriaxone or ceftazidime)
See Also
Sources
Uptodate