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PubMed1987

[Spinal epidural abscess--report of 5 cases].

We reported 5 patients with spinal epidural abscess. They were two men and three women. Their ages ranged from 48 to 56 years (mean, 53 years). In three out of 5 cases, the etiology was thought to be infection after lumbar discography, tracheostomy and lumber surgery. In the other two cases the etiology could not be determined. The abscess was located at cervical, thoracic and lumbar levels in 2, 1 and 2 cases, respectively. The interval between initial symptoms and operation was from 1 to 3 months. Purulent epidural collection was found in four cases at operation. Irrigation and drainage were sufficiently performed postoperatively in 4 cases. Antibiotic therapy had been continued for at least 8 weeks in every case. As demonstrated in the case 2, CT scan was very useful in determining the extension of the abscess and degree of the cord compression by the abscess. Also in the case 2, the epidural abscess extending from cervical canal to extracanalicular space was completely drained by applying draining tubes without laminectomy. The present results indicate that emergency laminectomy is not always necessary for the treatment of epidural abscess, especially in subacute or chronic cases.

Abscess↗
PubMed1979

Acute spinal epidural abscess.

A case of acute spinal epidural abscess is reported demonstrating many of the important features in the natural history of the disorder. The pathological changes in the cord at the level of the lesion are described. A series of 12 patients is reviewed. The average interval between the initial consultation and the onset of complete paralysis is 5 days and it is essential that the diagnosis is made during this period. Two indicators of prognosis are discussed--the duration of complete paralysis and the extent of sensory disturbance.

Abscess↗
PubMed2003

Cervical epidural abscess secondary to aorto-duodenal fistula: a case report.

Although cervical epidural abscess is rare, it should be strongly suspected in any patient with unexplainable neck pain and fever, especially when the patient has a predisposing factor for this infectious process. The authors report a case of cervical epidural abscess in a 39-yr-old man with an aorto-duodenal fistula, which complicated the interposition of artificial graft for abdominal aortic aneurysm rupture, which had undertaken 40 months before. Timely detection and intervention rendered him a full neurological recovery. This extremely rare case is presented with a literature review.

Adult↗
PubMed2001

Spinal epidural abscess due to Streptococcus pneumoniae in an HIV-infected adult.

Spinal epidural abscess (SEA) due to Streptococcus pneumoniae is rare and has never been reported in an HIV-infected patient, despite the higher risk of invasive disease in this group. We describe here the first case of pneumococcal epidural abscess, presenting with fever and back pain in a 60-year-old man infected with HIV. Blood cultures were positive for S. pneumoniae and magnetic resonance imaging (MRI) confirmed the suspicion of diskitis and SEA at the L4-S1 level. The patient was successfully treated with iv ceftriaxone without surgical intervention. The clinical characteristics of this case are compared with existing literature on pneumococcal SEA.

AIDS-Related Opportunistic Infections↗
PubMed1996

Intracranial epidural abscess: late complication of allograft cranioplasty.

A case of intracranial epidural abscess, 20 years after allograftic cranioplasty was presented. The abscess was caused by bacterial implantation after a minor stab wound of the scalp over the cranioplastic plate. It seemed quite rare that the intarcranial abscess occurred 20 years after an allograftic cranioplasty.

Abscess↗
PubMedDate not supplied

Spinal epidural abscess.

We present three cases of spinal epidural abscess. Initial presentation of localized spinal pain and tenderness along with fever should lead one to suspect the diagnosis. An emergency myelography and prompt treatment with appropriate antibiotics is necessary to prevent catastrophic neurologic deficit.

Abscess↗
PubMed1993

Intracranial epidural abscess: a report of three cases.

Intracranial epidural abscess is an uncommon but potentially life-threatening condition requiring prompt recognition and management. Most commonly it arises secondary to infection in the paranasal sinuses, mastoid air cells or the middle ear. It has also been described following craniotomy and trauma. This report describes three cases reported to our institution over a 15 month period, two associated with frontal sinusitis and one with no obvious predisposing factor.

Adolescent↗
PubMedDate not supplied

Cervical epidural abscess: approaches to diagnosis.

We report on two cases of cervical epidural abscess (CEA). Their clinical presentation included fever, neck pain and symptoms of neural compression, and the presence of epidural abscess was documented by surgery. Several imaging methods were used to establish a prompt diagnosis of CEA in both patients. Magnetic Resonance image provided a noninvasive means of visualize both extent in the spinal canal and paravertebral locations. None of the other currently used imaging modalities could provide the same information alone. The role of these techniques in diagnosing this condition is discussed.

Abscess↗
PubMed1987

Spinal epidural abscess: a rapidly progressive disease.

We report a case of spinal epidural abscess in a 42-year-old diabetic. The patient first presented with four days of low back pain with radicular symptoms following exertion. When he returned five days later with overt symptoms and signs of spinal cord compression, an epidural mass was diagnosed by myelogram and computed tomography scan. Following drainage of a large posterior epidural abscess, the patient was left with residual weakness requiring ongoing physical therapy.

Abscess↗
PubMed2001

Halo pin intracranial penetration and epidural abscess in a patient with a previous cranioplasty: case report and review of the literature.

STUDY DESIGN: Report of a patient with an epidural abscess after halo pin intracranial penetration at the site of a previous cranioplasty. OBJECTIVES: To report a rare case of intracranial penetration at the site of a previous cranioplasty associated with epidural abscess, and to discuss the diagnostic and therapeutic approach to its management. SUMMARY OF BACKGROUND DATA: The most serious complications associated with use of halo device occur when pins penetrate the inner table of the skull, resulting in cerebrospinal fluid leak and rarely in an intracranial abscess. However, no mention of intracranial halo pin penetration at the site of a previous cranioplasty was found in the literature. METHODS: A 64-year-old man with ankylosing spondylitis had a halo vest placed for management of a fracture dislocation through the C5-C6 intervertebral disc space associated with left C6 radiculopathy. One week later, the patient experienced fever and headache associated with pain, redness, and drainage at the site of the insertion of the left posterior pin. Computed tomography of the brain showed a 1.5-cm intracranial penetration of the halo pin through a previous cranioplasty of the temporal bone, associated with epidural abscess and cerebral edema in the left temporoparietal lobe. The pins and the halo vest were removed, the pin site was cleaned, and a Philadelphia cervical collar was applied. Staphylococcus epidermidis grew on the culture of drainage from the pin site. The patient started immediate intravenous antibiotic treatment for 2 weeks, followed by oral antibiotics for 2 additional weeks. RESULTS: The patient had gradual improvement of his symptoms within the first 48 hours. At the latest follow-up visit, he had fully recovered and his fracture had healed. CONCLUSIONS: The halo device should not be used for patients with a previous cranioplasty, especially if the pins cannot be inserted at other safe areas of the skull. A thorough medical history and physical examination of the skull are important before the application of a halo device. Computed tomography of the skull may be necessary before elective halo application for patients with concomitant head trauma, confusion, or intoxication and for patients with a previous cranioplasty to ascertain the safest pin sites.

Anti-Bacterial Agents↗
PubMed1998

Pediatric intracranial epidural abscess secondary to an infected scalp vein catheter.

The authors present a case of a 5-week-old infant developing a retrotorcular epidural abscess as a result of an infected scalp vein catheter. The abscess developed in the absence of sinusitis, otitis, trauma, or prior surgery. The diagnosis of epidural abscess was made on the basis of magnetic resonance imaging and ultrasound-guided aspiration of the fluid collection. An identified strain of Staphylococcus epidermidis was cultured from both the intravenous catheter and the abscess. The patient underwent a suboccipital craniectomy with drainage of the abscess and a 6-week total course of intravenous antibiotics. Magnetic resonance imaging 4 months after the procedure and 2.5-year pediatric clinic follow-up have demonstrated no evidence of neurologic deficit or recurrence. When present, a scalp vein catheter must be considered as an etiologic agent for an intracranial epidural abscess in this age-group.

Brain Abscess↗
PubMed1991

Diagnosis of anterior cervical spinal epidural abscess by US and MRI in a newborn.

A 10-day-old girl who initially presented with fever developed over five days a complete paresis of both upper arms and swallowing difficulty. After emergency drainage of a retropharyngeal abscess, cervical US demonstrated a cervical anterior epidural mass compressing the cord. MRI confirmed the diagnosis of spinal epidural abscess secondary to C4-C5 spondylodiscitis. Surgical removal of the abscess was followed by complete disappearance of the neurologic symptoms after six months of follow-up. This is the first case of spinal epidural abscess in a newborn to be diagnosed by US and MRI preoperatively. The advantages of these non-invasive imaging modalities are discussed, and compared to myelography.

Abscess↗
PubMed2001

Inappropriate medical management of spinal epidural abscess.

A 67 year old man with longstanding rheumatoid disease was referred to the regional spinal surgery unit with acute onset of paraparesis due to an extensive spinal epidural abscess of the lumbar spine. Ten months previously, he had started antibiotic treatment at another hospital for an epidural abscess arising at the level of the L2-3 disc space. Despite completing seven months of medical treatment with appropriate antibiotics, he had a recrudescence of acute back pain shortly after restarting methotrexate treatment. Urgent anterior spinal decompression with excision of the necrotic vertebral bodies of L1-3 was performed. The indications for the surgical management of spinal epidural abscess are reviewed.

Aged↗
PubMed1997

An epidural abscess due to resistant Staphylococcus aureus following epidural catheterisation.

We report a case of abscess formation after epidural analgesia, a rare complication that developed in our patient 13 days after placement of a thoracic epidural catheter for patient controlled analgesia. Culture of the pus grew methicillin-resistant Staphylococcus aureus. Although early diagnosis and rapid management have been reported to yield a satisfactory outcome, the case we describe ended in severe sequelae.

Abscess↗
PubMedDate not supplied

Epidural abscess causing cauda equina syndrome.

BACKGROUND: Spinal epidural abscesses are uncommon but are well documented in the literature as a serious causes of mortality and long-term neurological morbidity. AIM: We describe a case of a 57-year-old female who presented to Accident and Emergency with an acute exacerbation of long standing mild lower back pain with symptoms of cauda equina syndrome and a systemic infective process. CONCLUSION: The diagnosis of this condition requires a high index of suspicion. This report demonstrates that with adequate decompression and appropriate antimicrobial treatment a good outcome is achievable.

Acute Disease↗
PubMed1993

[Spinal epidural abscesses. Conservative treatment. Three cases].

Spinal epidural abscesses (SEA) are an infrequent disease which should be suspected in patients with spinal and/or radicular pain, neurologic deficits and fever. We present 3 patients with SEA (two lumbar and one dorsal) who recovered following exclusively antibiotic treatment. The complete disappearance of the abscess was proven by magnetic resonance. Patients with SEA and discrete, stable deficits and with known germs, are susceptible to medical and not surgical treatment.

Abscess↗
PubMed2000

Spinal epidural abscess in a young child.

This is a case report of a spinal epidural abscess, caused by Staphylococcus aureus, in a 3-year-old girl. The child presented with fever and hip pain, but without any neurologic deficit. After normal plain films and a normal bone scan were obtained, the diagnosis was made via magnetic resonance imaging (MRI). The neurosurgery and pediatric infectious disease teams evaluated the patient, and the decision was made to forego surgical drainage and to treat medically with appropriate intravenous and then oral antibiotics. Several months later, the child was doing well without any signs of neurologic sequelae. Because of the rarity of this disease in children, the treatment guidelines are controversial. Many suggest that a spinal epidural abscess must be drained surgically. Our experience adds to the literature a case of a child successfully treated with antibiotics alone. We believe that this success is related to the fact that the child was diagnosed by MRI early in the course of the disease and that she never displayed any neurologic deficits.

Anti-Bacterial Agents↗