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New perspectives in acute spinal epidural abscess. Illustrated by two case reports.

The histories of two patients with spinal epidural abscess are reported. Attention is drawn to the route of infection by means of direct inoculation of pathogens in the wake of paravertebral infiltration of local anaesthetics for relieving lower backpain, furthermore we emphasize the rare occurrence of a relapsing acute spinal epidural abscess. Additionally the diagnostic superiority of nuclear magnetic resonance tomography is described in a patient known to be allergic to commonly used contrast material.

Abscess↗

[MRI appearance of lumbar epidural abscesses: report of three cases].

The authors report three cases of non-tuberculous epidural abscess. Presenting symptoms included lumbar back pain, muscle spasms, soft tIssue swelling, and neurological deficits in all three cases. MR imaging was helpful for diagnosis and showed involvement of perivertebral soft tissues and an epidural abscess of variable size. There was no significant involvement of intervertebral disks or vertebrae. Diagnosis was confirmed by bacteriologic exam. Clinical outcome was favourable with antibiotic treatment.

Adolescent↗

Streptococcus pneumoniae endocarditis presenting as an epidural abscess.

Streptococcus pneumoniae is an important pathogen in many serious infections, such as pneumonia, sinusitis, and meningitis. It uncommonly causes infective endocarditis and only rarely produces spinal epidural abscesses. This report describes a patient who had pneumococcal infection presenting as an acute epidural abscess and who was subsequently found to have endocarditis. S. pneumoniae was cultured from both blood and abscess material. A high level of clinical suspicion of endocarditis is important in all cases of bacteremic pneumococcal illness; patients with such an illness and back pain may harbor potentially catastrophic epidural abscesses.

Abscess↗

Acute purulent discitis with epidural abscess of the cervical spine in an adult--case report.

A 52-year-old male presented with acute purulent discitis and epidural abscess of the cervical spine manifesting as neck pain and slight fever, followed by sudden onset of quadriparesis. Magnetic resonance (MR) imaging showed a low-signal-intensity area in the C6/7 disc space and epidural space ventral to the spinal cord with peripheral enhancement. Surgical exploration using an anterior approach revealed local discitis and epidural abscess, but no osteomyelitis of the neighboring vertebral bodies. Six months after the decompressive procedure to treat the purulent disc and epidural abscess, he had achieved almost full recovery. Such lesions are rare in adults, but should be considered especially when painful spinal symptoms are associated with fever. Early and definitive diagnosis can be achieved by MR imaging with enhancement.

Brain Abscess↗

[Spinal epidural abscess in an 11-year-old boy (author's transl)].

Spinal epidural abscesses can occur in childhood. Neurological defects are late manifestations in the course of this disease. Recognition of the early symptoms followed by immediate neurosurgical intervention can prevent these defects. This report describes the course of an epidural abscess in an 11 year old boy. The painful febrile spinal syndrome of the cervical column was the outpointing initial symptom. Lateron disturbances of the autonomic nerve function appeared, such as acute abdomen. The differential diagnosis of the early symptoms is discussed.

Abdomen, Acute↗

Infectious agents in spinal epidural abscesses.

Of 27 cases of spinal epidural abscess, 19 were caused by bacteria, 7 by Mycobacterium tuberculosis, and 1 by Echinococcus granulosus. Blunt trauma and cutaneous infections were the most frequent preceding events in bacterial cases. Tuberculous abscess was usually the sole manifestation of reactivation of dormant tuberculosis. Drug addiction, the most common cause in young adults, was associated with gram-negative infections. Whatever the infectious agent, paraparesis for longer than 4 days led to a poor outcome. Myelography was the best diagnostic test, whereas lumbar puncture and percutaneous bone biopsy offered little specific information.

Abscess↗

Spinal epidural abscess: evaluation of factors influencing outcome.

OBJECTIVE: The goal of this study was to critically evaluate the predictive efficacy of various clinical factors in spinal epidural abscess influencing outcome after surgical and/or medical treatment. METHODS: A retrospective analysis of 41 cases of spinal epidural abscess treated at Henry Ford Hospital between 1984 and 1992 was performed. RESULTS: Thirty patients underwent open surgery and received antibiotic therapy, and 11 patients received medical treatment alone. After a mean follow-up period of 20.9 months (range, 4-45 mo), 24 patients (58.5%) had no or minimal deficits, 9 patients (22%) had severe paresis or plegia and/or bowel/bladder dysfunction, and 8 patients (19.5%) died. Univariate analysis revealed patient age, degree of thecal sac compression, spinal location, surgical findings, and septic presentation to be significantly associated with outcome. In multiple logistic regression analysis, increasing age and degree of thecal sac compression were the only factors with significant independent association with poor outcome (P = 0.01 for both). A simple grading system (Grades 0-III) was developed, with patient age, degree of thecal sac compression, and duration of symptoms as the determining criteria. The incidence of poor outcome for patients with Grade 0 was 0%, compared to 85.7% for patients with Grade III. CONCLUSION: We conclude that long-term outcome after treatment of spinal epidural abscess can be predicted with the use of the proposed grading scheme. Surgical drainage plus parenterally administered antibiotics remains the recommended treatment, although medical treatment alone can also be used for certain patients.

Abscess↗