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PubMed2003

Epidural abscess in a patient with dorsal hyperhidrosis.

PURPOSE: To report the management of a patient who developed a lumbar epidural abscess when an epidural catheter was placed three years after a thoracic sympathectomy. The possible contribution of hyperhidrosis is discussed. CLINICAL FEATURES: A 62-yr-old male had compensatory hyperhidrosis in his back after thoracic sympathectomy. The patient, who suffered from thromboangeitis obliterans, underwent lumbar (L2-3) epidural catheterization in order to improve arterial circulation and ameliorate resting pain in his left leg. On the third day after catheterization, the patient complained of a dull pain in his back. Emergency magnetic resonance imaging revealed a 12-mm abscess in the epidural space. On the tenth day after catheterization, laminotomy at the 3-4 lumbar vertebrae and local drainage were performed. A 14-mm abscess was removed from the epidural space. The patient was discharged on day 21 after catheterization without any disability. CONCLUSION: Special precautions against infection may be necessary in patients with hyperhidrosis in the area where continuous epidural catheterization is attempted.

Anesthesia, Epidural↗
PubMed1996

Spinal epidural abscess in hemodialysis patients: report of three cases and review of the literature.

Spinal epidural abscess (SEA) is a rare infection that can evolve to severe permanent neurologic deficit or death if the diagnosis is delayed. We report three cases of SEA in hemodialysis patients and summarize nine previously reported cases occurring in hemodialysis patients, with detailed comparisons to series of SEA from the general medical literature. Among these 12 patients, hemodialysis catheters and arteriovenous grafts were the major source of infection, in contrast to the usual skin source. Staphylococcus aureus was implicated in all cases, but in one patient Bacteroides fragilis also was isolated from both the resected arteriovenous fistula and the SEA, and Escherichia coli was isolated from the arteriovenous fistula. The classic syndrome of SEA includes fever, backache, and local spinal tenderness, followed by progressive radicular and cord compression signs and symptoms. In this series, back pain and radicular pain were common at presentation, but only a minority had fever, back tenderness, weakness, or leukocytosis. Cerebrospinal fluid was typically abnormal but culture negative, whereas blood and epidural abscess cultures were frequently positive. Plain x-ray films, bone scans, and plain computed tomography scans had low diagnostic yield, and magnetic resonance imaging with gadolinium had a sensitivity of 80%. Only myelography or computed tomography-myelography gave consistently correct diagnoses. The clinical outcome was poor, with one patient deceased and seven with severe weakness or paralysis. Early intervention provided a higher likelihood of good outcome, whereas late intervention and preoperative neurologic deficits portended a poor functional result. Because of the high incidence of bacteremia in hemodialysis patients, we recommend that symptoms of fever, backache, and spinal tenderness be promptly evaluated for SEA before signs or symptoms of cord compression develop. Early recognition and treatment with antibiotics and decompressive laminectomy is generally associated with a better outcome.

Abscess↗
PubMed1987

Subdural empyema and epidural abscess: recent experience in a community hospital.

We treated 31 cases of localized central nervous system infection over a seven-year period in our community hospital. The causes included brain abscess in 18 cases (58%); cranial subdural empyema (CSE) in six cases (20%); spinal epidural abscess (SEA) in four cases (13%); cranial epidural abscess (CEA) in two cases (6%); and spinal subdural empyema (SSE) in one case (3%). Both CSE and CEA were often caused by sinusitis and manifested by fever, headache, altered sensorium, and focal neurologic signs. Treatment consisted of drainage by burr holes or craniotomy followed by long-term administration of parenteral antibiotics. Though all patients with CSE and CEA survived, half had severe residual neurologic deficits. Both SEA and SSE were manifested by fever, spinal pain, and loss of motor function, and both were treated by laminectomy drainage and antibiotic administration. One patient died and three of the other four had residual neurologic deficits or back pain. Diagnosis of CSE and CEA was facilitated by CT scanning, while clinical examination, CT scanning, and myelography were useful in diagnosing SEA; SSE was not suspected preoperatively.

Abscess↗
PubMed1999

Epidural abscess: a delayed complication of esophageal stenting for benign stricture.

A case of anterior cervical epidural abscess associated with perforation of an endoscopically placed esophageal stent is presented. Although delayed esophageal perforation is a known complication of endoscopic stenting, no cases presenting with epidural abscess have yet been reported. The increasing application of endoscopic stenting for benign esophageal strictures provides greater opportunity for this type of delayed complication.

Abscess↗
PubMed2000

Lumbar osteomyelitis and epidural abscess complicating recurrent pilonidal cyst: report of a case.

PURPOSE: This study was conducted to report the rare presentation of lumbar osteomyelitis and epidural abscess as a complication of a pilonidal cyst. METHODS: A case report is presented. RESULTS: We describe the rare case of a male patient with diabetes with a recurring pilonidal cyst who developed a lumbar osteomyelitis and epidural abscess three weeks after pilonidal cyst excision with epidural anesthesia, with a fatal outcome despite emergency treatment. CONCLUSIONS: Life-threatening complications should be kept in mind in high-risk patients with repetitive surgery and neurologic involvement.

Epidural Abscess↗
PubMed2006

Cervical spine epidural abscess: experience with microsurgical treatment in eight cases.

OBJECT: The authors report a series of eight consecutive cases in which epidural abscesses in the cervical spine were treated by microsurgery without arthrodesis, including two cases of concomitant pyogenic and tubercular infection. METHODS: The authors used a minimally invasive surgical approach consisting of single-level anterior microsurgical discectomy and drainage of the epidural abscess via a silicone catheter, and then initiated antibiotic therapy. At follow-up examination (mean duration 39 months), six patients exhibited complete recovery and two suffered from minor residual deficits. In all cases, spontaneous vertebral fusion occurred. Sagittal alignment was maintained in seven patients, and in one there was slight asymptomatic kyphosis. In two patients, tubercular and pyogenic infections were found. Prior intervention for dental infection was recorded in four cases. CONCLUSIONS: In the absence of preoperative spinal instability, microsurgical drainage of the abscess followed by specific antibiotic therapy resulted in spinal cord decompression and neurological recovery, thereby facilitating spontaneous fusion and vertebral stability. The presence of combined tubercular and pyogenic infections of the cervical spine should be considered, especially in patients whose immune systems are depressed.

Adult↗
PubMed1997

Epidural abscess after lumbar discography. A case report.

STUDY DESIGN: The patient who suffered from pain in both lower legs and in whom discography was performed experienced a rare complication after discography. The findings and method of discography is described, as is usefulness of magnetic resonance imaging to image this rare complication. OBJECTIVES: To establish the possibility of getting a spinal epidural abscess after discography, how to make the diagnosis, and how to treat the complication. SUMMARY OF BACKGROUND DATA: Discitis after discography is a well-known complication, but epidural abscess is rare. METHODS: C-reactive protein concentration was measured and was more than 100 mg/L. Infection was suspected, and antibiotic therapy was started immediately. Magnetic resonance imaging was performed, and the diagnosis became clear. A laminotomy was performed. RESULTS: Symptoms due to epidural abscess disappeared soon after laminotomy. CONCLUSIONS: Some harmful and unpleasant complications are possible after discography. Antibiotic prophylaxis and stiletted needles should be used. Magnetic resonance imaging is the best radiologic procedure to image the complication, and surgery must be performed as soon as possible.

Abscess↗
PubMed1985

Salmonella vertebral osteomyelitis and epidural abscess in a child with sickle cell anemia.

A case of Salmonella vertebral osteomyelitis with epidural abscess in a child with sickle cell anemia is presented. Spinal osteomyelitis is a rare event in children. Although osteomyelitis in sickle cell anemia may occur in any bone, it has most often been documented as beginning in the medullary cavity of the long and tubular bones. This is in contrast to the clinical presentation of osteomyelitis in the normal individual, who is likely to have infection beginning in and restricted to the metaphyseal regions of bones. Nonspecific or constitutional symptomatology may obscure the diagnosis of vertebral infection with ensuing cord compression. This case stresses the rapidity of development of paralysis or other neurologic complications, as well as the difficulty and emergent nature of the diagnosis of epidural abscess in this situation.

Abscess↗
PubMedDate not supplied

Spinal epidural abscess.

In a retrospective study, 68 patients with Spinal Epidural Abscess (SEA) were reviewed. Of these, 66% had different predisposing factors such as staphylococcal skin infections, surgical procedures, rachicentesis, trauma, spondilodiscitis. Abscess had a lumbar region location in 53% of cases. Staphylococcus aureus was the most frequent etiological agent (81%). The overall rate of mortality in SEA patients was 13.2%.

Adolescent↗
PubMed2004

Surgical management of spinal epidural abscess: selection of approach based on MRI appearance.

Spinal epidural abscess (SEA) is associated with considerable morbidity and mortality despite its infrequent occurrence. The evolution of magnetic resonance imaging has allowed for easier diagnosis of this potentially devastating condition. It is also possible to predict the intraoperative appearance of each individual case of SEA prior to the procedure, based on the MR findings. Surgical treatment of SEA usually involves extensive decompressive laminectomy, predisposing the patient to the development of spinal instability and deformity. Recent advances in surgical approach to SEA have seen the institution of less invasive techniques to manage this condition, including washout of the epidural space with catheters introduced via laminotomy. Our three cases illustrate the ability to predict the intraoperative findings in patients with SEA, and accordingly adjust the surgical approach to minimize the extensiveness of potentially destabilizing procedures, without impinging on the effectiveness of treatment.

Adolescent↗
PubMed2000

Spinal epidural abscesses in children: a 15-year experience and review of the literature.

We reviewed medical records and laboratory and diagnostic evaluations for 8 pediatric patients with spinal epidural abscesses who were treated during the last 15 years at our institution. Staphylococcus aureus was isolated from 5 of 8 epidural abscesses, including 2 abscesses with methicillin-resistant S. aureus. Unusual isolates were group B Streptococcus in a patient with chronic vesicouretral reflux associated with the posterior urethral valves and Aspergillus flavus in a patient with acute myelogenous leukemia. An analysis incorporating our results and a review of the English-language literature about abscesses in children and adults revealed differences related to age. Abscesses in children were more posterior in epidural location, had greater spinal column extension, and were associated with more favorable clinical outcomes than were abscesses in adults. Magnetic resonance imaging is the diagnostic procedure of choice; however, radionuclide bone scans should be considered for associated distant osteomyelitis in children. Prompt diagnosis and combined medical and surgical treatment remain the cornerstones for the prevention of adverse outcomes.

Adolescent↗
PubMed2002

Spinal epidural abscess in a neonate.

A case of purulent spinal epidural abscess in a 20-day-old girl is presented. The patient had symptoms of fever, localized back pain and swelling over the interscapular area. The diagnosis was made by magnetic resonance imaging. Purulent material grew Staphylococcus aureus from the lesion. Because of severe cord compression surgical laminotomy and drainage were performed, and antibiotics were administered. One year later she was doing well without neurologic sequelae.

Amikacin↗
PubMed1990

Occipital epidural abscess causing superior sagittal sinus obstruction.

The case of a 73-year-old farmer with occipital epidural abscess causing superior sagittal sinus obstruction is reported. Surgical removal of the epidural abscess relieved the obstruction of the superior sagittal sinus (SSS). Early, accurate diagnosis of this entity by X-ray computed tomography (CT) was important in the present case, as was cerebral angiography and immediate neurosurgical intervention.

Aged↗
PubMed1996

Spinal epidural abscess--review of 10 cases.

Abscess formation in the spinal epidural space is a very rare lesion, occurring once in 10,000 admissions to a tertiary centre and often requiring emergency neurosurgical treatment commonly presenting late. We present our experience of ten cases of spinal epidural abscess treated at our institution between January 1984 and July 1994 and review the most recent literature.

Abscess↗
PubMed2003

Title comparison of primary and secondary spinal epidural abscesses: a retrospective analysis of 29 cases.

BACKGROUND: Spinal epidural abscesses (SEA) are uncommon. In certain regions their incidence is rising. Vague initial presentation may result in delayed diagnosis. Familiarity with SEA is imperative because if not treated expeditiously, they can have devastating neurologic sequelae. METHODS: A retrospective analysis using analysis of variance (ANOVA) was performed on patients diagnosed with SEA between 1980 through 2000. The patients were assigned to one of the two defined groups: primary (PSEA) consisted of SEA alone; secondary (SSEA) included SEAs with vertebral osteomyelitis. Both groups were compared for factors including survival, age, diagnostic accuracy, etiology, hospitalization, management, and outcome. RESULTS: Twenty-nine cases were identified. Four (23.7%) were PSEAs and 25 (86.2%) were SSEAs. Mean age (52.7 vs. 53.2 years) and mean duration of hospitalization (39.2 vs. 38.6 days) were comparable in both groups (p = 0.9). The admitting diagnosis was correct in 75% of PSEA and 20% of SSEA cases (p = 0.1). Staphylococcus aureus was present in 75% and 68%, respectively. In SSEA cases, 24% (n = 6) of the infections were consequent to spinal surgery. PSEA did not show a predilection for any level. Most (56%) cases of SSEA occurred at the lumbar levels. The entire PSEA group and 58.3% of the SSEA group underwent surgery (p = 0.06), 75% versus 40.9% had a good outcome for PSEA and SSEA, respectively. CONCLUSIONS: PSEAs are very rare. Both groups have similar characteristics. Staphylococci remain the predominant etiologic agent. PSEAs are treated by surgery; SSEAs are managed surgically or conservatively.

Epidural Abscess↗
PubMed1975

[Chronic spinal epidural abscess (author's transl)].

A case of 58 year old female with chronic spinal epidural abscess demonstrating rapid progression of complete spinal cord paralysis without remarkable recovery by laminectomy was reported. Patient had a large subcutaneous abscess on left back, ten years ago. Three months before admission she fell down from stairs and had a compression fracture on the seventh thoracic vertebra. She has been troubled with slight spinal ache and left lower back pain since the fall accident. One month before admission she suddenly noted severe lower back pain with radiation to left side and the pain became more severe. Three weeks after she noted fecal retention without urinary retention. Five days before admission she noted gait disturbance accompanied by numbness of both foots. Three days later she developed inability to urinate and the same day, over the coure of a few hours, she became total paraplegia and anesthesia below the waist. On admission neurological examination and myelography disclosed complete spinal subarachnoid block with flaccid total paraplegia and anesthesia below the lower chest. The clinical diagnosis was spinal epidural mass lesion, probably neoplasm. Laminectomy from Th-6 through Th-9 was performed the next day: three days after complete paralysis. The epidural abscess included pus and soft granulation tissue was found and totally removed. Staphylococcus aureus sensitive to penicillin, chloramphenicol etc. was isolated on becteriologic culture. On seven months after operation, sensory and deep reflexes were considrable improved, but she remained paraplegic without sphincter control. Dicussion were made on the incidence, pathogenesis.

Abscess↗