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PubMed2004

Spinal epidural abscesses: a retrospective analysis of clinical manifestations, sources of infection, and outcomes.

BACKGROUND: Spinal epidural abscess (SEA) is uncommon but has a potentially disastrous outcome. Its early recognition and management may lead to satisfactory results. We analyzed the clinical manifestations, sources of infection, and outcomes of patients with SEA. METHODS: Between 1997 and 2003, 17 patients in the Department of Neurosurgery at Keelung Chang Gung Memorial Hospital had SEA. We retrospectively reviewed their records to analyze their clinical presentations, image findings, laboratory data, and clinical outcomes. RESULTS: All 17 patients (mean age, 63 years) underwent surgery and received antibiotics. Back and/or neck pain (82%), motor deficits (70%), and elevated C-reactive protein levels or erythrocyte sedimentation rates (64%) were the most common symptoms and signs. The most common etiological organism was oxacillin-resistant Staphylococcus aureus. The SEA was most commonly located in the lumbar spine, anterior to the spinal canal. Outcomes were poor in 29% of the patients, fair in 18%, and good in 53%. CONCLUSIONS: Abdominal complications in patients with spinal disease are not uncommon, especially when the thoracic level is involved. The abdominal symptoms may initially mask neurological deficits due to spinal cord involvement, however, spinal pain and motor deficits present in most cases under more thorough investigation. In a suspected SEA patient with a history of gouty arthritis, tissue biopsy should include additional crystal analysis. Although the increasing availability of MRI makes diagnosis easier and quicker, repeated neurological examination and full evaluation are essential in any patient with an unknown focus of infection and spinal pain or tenderness.

Adult↗
PubMed2000

Epidural abscess masquerading as lateral sinus thrombosis.

Controversy regarding the use of anticoagulants, the evacuation of the sinus, or the use of medical treatment alone surrounds the treatment of lateral sinus thrombosis. Treatment of an epidural abscess associated with coalescent mastoiditis is much less controversial-drainage is usually recommended. The differing treatments of these complications mandate accurate diagnosis. The advent of more sophisticated radiological studies has facilitated diagnosis of these complications; however, tests are not infallible. We present three cases in which preoperative imaging demonstrates an epidural abscess mimicking lateral sinus thrombosis by compression of the vessel. A false-positive computed tomography (CT) or magnetic resonance imaging (MRI) study may lead to the wrong diagnosis and, consequently, improper treatment. In light of this possibility, we recommend surgical exploration in all such cases.

Case Reports↗
PubMed1992

Iatrogenic acute spinal epidural abscess with septic meningitis: MR findings.

A contaminated catheter used in epidural anesthesia in a 71-year-old female produced acute epidural abscess and septic meningitis. Methicillin-resistant Staphylococcus aureus (MRSA) was detected in a culture of the epidural pus. Both T1- and T2-weighted MR images showed low intensity mass lesion compressing the thecal sac behind the vertebral body L3. The low intensity lesion was probably pus with gas component. In these low intensity lesions in MR findings with gas component, MR was superior to myelography because it visualized both the degree of compression to the thecal sac and extension of the lesion in all directions.

Abscess↗
PubMed1996

Spinal epidural abscess: an unusual cause of sciatica.

A previously healthy patient was admitted to our hospital because of low back pain and sciatica. For 4 weeks preceding the admission, he had been treated with nonsteroidal antiinflammatory analgetics and bed rest with a clinical diagnosis of lumbar disc herniation. On admission, the patient was subfebrile but developed general symptoms of septic infection by the next day. Computed tomography and magnetic resonance imaging of the lumbar spine revealed a spinal epidural abscess and spondylodiscitis at the L5-S1 level. During an emergency laminotomy, gross pus in abundance was evacuated from the epidural space; microbiological cultures from the pus and blood yielded Staphylococcus aureus. The unique clinical presentation of our patient combined with merely indolent symptoms of infection delayed the correct diagnosis. We are not aware of any similar reports of patients with lower spinal epidural abscess whose primary presentation was sciatic pain.

Abscess↗
PubMed2004

[Takotsubo cardiomyopathy thought to be induced by MRSA meningitis and cervical epidural abscess in a maintenance-hemodialysis patient: case report].

A 65-year-old man was admitted to our hospital for high fever and severe left shoulder pain. He was initiated on maintenance hemodialysis for end-stage renal failure caused by diabetic nephropathy 9 years previously. On admission, the serum CRP level was 29.3 mg/d/l and the white blood cell count was 29,000/mm3. Bacterial examination of blood and spinal fluid revealed MRSA colonization. On the 6th hospital day, a giant negative T wave in the V2-6 leads of an electrocardiogram asymptomatically appeared. Ultracardiogram revealed apical systolic paradoxical centrifugal motion. None of the cardiogenic enzymes, such as creatine kinase, lactate dehydrogenase and glutamic oxaloacetic transaminase was elevated. Cardiac thallium-201-chloride (201Tl-Cl) and I-123 beta-metyl iodophenyl-pentadecanoic acid (123I-BMIPP) scintigraphy revealed a decreased accumulation of isotopes in the apex. From these findings, we diagnosed Takotsubo cardiomyopathy induced by MRSA meningitis. Vancomycin was administrated and the inflammatory signs decreased. On the 46th hospital day, tetraplegia and respiratory suppression occurred. A cervical spinal magnetic resonance image revealed cervical spondylodiscitis and cervical epidural abscess, which compressed the medulla oblongata. Surgical spinal decompression and drainage of the abscess were performed. The giant negative T wave in the electrocardiogram improved after the operation. Two months after the operation, cardiac 201Tl-Cl scintigraphy revealed improvement in the accumulation of isotopes in the apex. Takotsubo cardiomyopathy is secondary cardiomyopathy presenting with apical systolic paradoxical centrifugal motion without coronary stenotic disease. It has been reported to be induced by severe mental stress or intracranial disease. In the present patient, it was predicted that stress on the central nerve system caused by the MRSA meningitis and the cervical epidural abscess induced the Takotsubo cardiomyopathy.

Cardiomyopathies↗
PubMedDate not supplied

Spinal epidural abscess: an unusual complication of bacterial endocarditis.

We are reporting a case of epidural abscess complicating bacterial endocarditis. To the best of our knowledge, this association has not been reported before. Streptococcus sanguis was isolated from the blood. A full recovery followed surgery and antibiotic therapy. The relevant characteristics of both diseases are reviewed. No explanation for this rare association is available as yet.

Abscess↗
PubMed1997

[Spinal epidural abscess due to Fusobacterium nucleatum].

We report a case of spinal epidural abscess. In our knowledge this is the first ever reported case due to Fusobacterium nucleatum. An 83 year old female patient with a history of lumbar trauma presented severe lumbalgia. Magnetic resonance showed the unusual anterior location, complicated by psoas abscess. Laminectomy and lumbar drainage were performed. She was treated with ceftriaxone plus metronidazole during 10 days. The evolution was favourable without any residual neurological morbidity.

Abscess↗
PubMed1990

Spinal epidural abscess: a ten-year perspective.

A retrospective study of spinal epidural abscess spanning 10 years and encompassing 40 patients was done. Epidemiology, clinical features, laboratory findings, radiographic imaging, therapy, and outcome were examined and compared with previous series. An increasing incidence of the disease (up to 1.96 patients per 10,000 admissions per year) and an older, more debilitated population (67% having factors predisposing them to infection) were discovered. Over half of the population was studied with magnetic resonance imaging, which was found to be equally as sensitive (91%) as myelography with computed tomography (92%). Magnetic resonance imaging offers the advantages of being noninvasive and able to delineate other entities, which makes it the imaging modality of choice. Preoperative paralysis and neurological deterioration from normal were identified as poor prognostic features. Of 7 patients with preoperative paralysis, 5 died, and the rest failed to recover neurological function. Eleven patients with initially normal neurological exams deteriorated in the hospital before surgical intervention. Eight of these patients were being treated with appropriate antibiotics; 2 became paralyzed despite more than 3 weeks of antibiotic therapy. Only 3 of these 11 patients recovered fully. Immediate surgical decompression combined with antibiotics remains the treatment of choice.

Abscess↗
PubMed2005

An epidural abscess following transrectal ultrasound-guided biopsies of the prostate.

We report the occurrence of an epidural abscess following TRUS-guided prostate biopsies, which highlights the fact that severe complications may occur with this technique in spite of antibiotic prophylaxis. Ciprofloxacin-resistant Escherichia coli is a frequent cause of fever following TRUS-guided prostate biopsies as was the case in our patient. Early suspicion of the presence of ciprofloxacin-resistant Escherichia coli may help avoid serious complications in these patients.

Biopsy↗
PubMed2000

[Vertebral osteomyelitis with epidural abscess in a child with sickle cell disease].

A case of paraplegia due to a thoracic epidural abscess in a 6-year-old black girl with sickle cell anemia is reported. MRI and CT scan showed abnormalities involving T6 vertebra which were consistent with osteomyelitis. A laminotomy, associated to antibiotic administration, permitted rapid neurological improvement. Although cultures were negative, the infection was probably due to salmonellae. Salmonellosis is a well-known complication in children with sickle cell disease but spinal localization is unusual. Its pathogenesis is unclear but immunological abnormalities associated to vascular obstructions by abnormal blood red cells have been advocated. The underlying etiology of vertebral abnormalities in these children is difficult to determine, but early diagnosis with modern investigations, as CT scan and MRI, is crucial to promptly begin therapy for osteomyelitis, minimizing the risk of spinal cord compression.

Anemia, Sickle Cell↗
PubMed2001

[Epidural abscess following delivery with peridural analgesia. The question of prevention].

A 35-year-old healthy gravida 2 para 2 developed a spinal epidural abscess after uneventful obstetric epidural analgesia. The diagnosis was confirmed by gadolinium-enhanced MRI; immediate surgical drainage combined with long-term antibiotic treatment led to complete recovery. The symptoms and possible contributing factors (e.g. immunological impairment of the patient, duration of the catheterization, violation of hygienic standards, type of disinfectant and dressing) are discussed. Vigilance is essential to avoid complications in patients with epidural catheters, even after it has been removed, in order to introduce appropriate diagnostic and therapeutic measures without delay. Immediate treatment is decisive for long term prognosis which should be introduced before neurological dysfunction appears.

Abscess↗
PubMed2002

Primary cutaneous nocardiosis with epidural abscess caused by Nocardia brasiliensis: a case report.

Dissemination of primary cutaneous nocardiosis is a rare event. An interesting case of a 20 year old female labourer with progressive weakness in both the lower limbs and large multiple subcutaneous abscesses over the back, since 4 years, is presented. MRI showed an epidural abscess compressing the cord. Histopathology of skin lesions suggested a chronic suppurative lesion. Microbiological tests on the aspirate from the skin lesion identified the causative organism as Nocardia brasiliensis.

Adult↗
PubMed2005

[Spinal epidural abscess without spondylodiscitis. Description of four cases].

We performed a retrospective study about patients diagnosed of spinal epidural abscess without concurrent spondylodiscitis, collected in the last five years in our hospital. We describe four patients, all of them males, with ages ranged from 59 to 67 years old. All patients presented fever, elevated phase reactants and spinal pain, with cord compression in three of them. Two patients had risk factors: diabetes mellitus and non-Hodgkin lymphoma. S. aureus was isolated in three patients, and S. agalactiae in the other one. The posterior epidural space was the most frequently affected, with variable location along the spinal cord. Three patients required surgical operation, and the other one was treated only with antibiotics. All patients demonstrated a complete clinical, analytical and radiological resolution.

Aged↗
PubMed1981

[Spinal epidural abscesses: report of 5 cases].

Five cases of acute spinal epidural abscess, all in male, two of them in children (6 and 7 years old) and the others in patients older than fifty years are reported. In four cases the pathology was related to skin infection and the staphylococcus was the main agent. All the patients had a severe infectious clinical picture, pain on the spine, radicular or spinal cord involvement or both. There was a delay in diagnosis showing that this pathology is still rather unknown. The cases were treated surgically. Two patients died, two had a complete recovery and the last one recovered with neurological deficit. The patients who died had impairment of the cervical cord and were operated on in very bad general and neurological conditions. Revision of literature was performed and the authors discussed the various aspects of this disease.

Abscess↗
PubMed1994

Spinal epidural abscess: an elusive diagnosis.

This case illustrates the enigmatic fashion in which spinal epidural abscess (SEA) may manifest. In any patient with back pain and fever of unclear etiology, the diagnosis of SEA should be considered; this is particularly true when radicular symptoms are present. Some patients with SEA may not have a source of infection. SEA constitutes a neurosurgical emergency; with timely intervention, the morbid neurologic sequelae that can result once weakness or paralysis have occurred can be avoided.

Abscess↗
PubMed2003

Spinal epidural abscess: study of early outcome.

OBJECTIVE: To evaluate the course, complications, and outcomes of individuals with spinal epidural abscess (SEA) and to compare these factors in individuals who had sustained a traumatic spinal cord injury (TSCI). METHOD: This is a retrospective study evaluating risk factors, functional change, and neuromedical complications. Thirty-two adults with SEA, treated on a rehabilitation unit at an urban university medical center, were compared with 32 individuals with TSCI. Groups were matched by lesion level and American Spinal Injury Association classification. RESULTS: Both groups made significant functional improvement as measured by the functional independence measure (FIM), although the SEA group only averaged a 15-point increase, whereas the TSCI group averaged approximately 30 points. When compared with the TSCI group, the SEA group had a higher frequency of pressure ulcers (P < 0.04), and exhibited greater intravenous drug use (P < 0.008). There were no differences between the groups with respect to discharge placement or neuromedical risk factors. CONCLUSION: A number of predisposing factors and neuromedical complications that have significant medical implications were noted in the SEA group. In general, predisposing factors and outcomes were similar between those with SEA and those with TSCI, except for drug use and rate of pressure ulcers. These factors do not appear to relate to differential outcome in discharge placement, however. Although it is important to be aware of factors that place an individual at risk for SEA and appreciate the risks for complications, significant functional improvement can be achieved in this population.

Activities of Daily Living↗
PubMed1999

Spinal epidural abscess: correlation between MRI findings and outcome.

Our purpose was to determine if specific MRI findings in spinal epidural abscess (SEA), at the time of diagnosis, are associated with the clinical outcome. The clinical records and MRI studies of 18 patients with SEA were reviewed and follow-up was obtained from the outpatient medical record, telephone interview, or both. The association between findings on contrast-enhanced MRI and clinical outcome (weakness, neck or back pain, and incomplete functional recovery) was evaluated. With univariate analysis, narrowing of 50% or more of the central spinal canal (P = 0.03), peripheral contrast-enhancement (P = 0.05), and abnormal spinal cord signal intensity (P = 0.05) were associated with weakness at follow-up. Persistent neck or back pain was associated with spinal canal narrowing (P = 0.02), peripheral contrast-enhancement (P = 0.02), and an abscess longer than 3 cm (P = 0.04) on MRI. Incomplete clinical recovery was associated with both abscess length (P = 0.01) and the severity of canal narrowing (P = 0.01). Abscess length, enhancement pattern, and severity of canal narrowing can be incorporated in a grading system that can be used to predict outcome.

Chi-Square Distribution↗