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Epidural abscess presenting as severe depression with suicidal ideations: Case report.
Erin D'Agostino1, Vyacheslav Makler2, David F Bauer2
1Geisel School of Medicine, New Hampshire, Lebanon, New Hampshire, United States.
Surgical Neurology International
|May 10, 2018
Summary
Epidural abscess (EDA) can mimic chronic subdural hematoma and present atypically with psychiatric symptoms like depression. Early diagnosis and treatment are crucial for resolving these unusual neurological and psychiatric manifestations.
Area of Science:
- Neurology
- Neurosurgery
- Infectious Diseases
Background:
- Epidural abscess (EDA) is a rare intracranial infection typically presenting with fever, headache, and focal neurological deficits.
- Characteristic imaging findings include lentiform collections with restricted diffusion.
Observation:
- A 57-year-old male with a history of epilepsy and remote traumatic brain injury presented with three weeks of depression and suicidal ideation.
- Initial magnetic resonance imaging suggested a chronic subdural hematoma (SDH), and the patient lacked typical infectious signs.
Findings:
- Operative findings revealed purulence in the epidural space, confirming an epidural abscess.
- Postoperative antibiotic treatment led to the resolution of the patient's depression and suicidal ideations.
Implications:
- Epidural abscess can present atypically, particularly in patients with a history of cranial procedures.
- Depression and suicidal ideation should be considered as potential, albeit uncommon, presenting symptoms of EDA.
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