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PubMed2004

Methicillin-resistant Staphylococcus aureus epidural abscess after transforaminal epidural steroid injection.

Transforaminal epidural steroid injections are provided frequently for patients with lumbar radiculopathy, having demonstrated efficacy and safety. We present a patient who developed methicillin-resistant Staphylococcus aureus epidural abscess 11 days after a transforaminal epidural steroid injection. The abscess required surgical intervention and intravenous vancomycin. Fortunately, the patient made a full recovery, and continues to do well one year later. The incidence, etiology and treatment of epidural injection-related infections are reviewed.

Journal Article↗
PubMed1987

Acute epidural abscess.

Acute epidural abscess is a neurosurgical emergency requiring prompt diagnosis and treatment. The devastating consequences of delayed or missed diagnosis require consideration of acute epidural abscess in the differential diagnosis of back pain. Knowledge of the natural history and presentation of this disease will allow its early recognition and minimize the morbidity and mortality resulting from misdiagnosis. We present a case of advanced pneumococcal epidural abscess complicated by pneumococcal meningitis and review the literature on this subject.

Abscess↗
PubMed2003

[Late onset of spinal epidural abscess after spinal epidural catheterization].

A 76-year-old diabetic woman received epidural catheterization for sigmoid colectomy. Four months later she started to complain of fever and severe lumbago, and finally fell into coma and tetraplegia. She had severe neck stiffness, and lumbar puncture yielded yellowish pus. Methicilin-resistant Staphylococcus aureus (MRSA) was detected in a culture of the epidural pus and blood as a causative organism. Magnetic resonance imaging showed extensive abscess in the posterior epidural space at the level between Th1 and L5. We diagnosed her disease as iatrogenic spinal epidural abscess due to epidural catheterization. After emergent laminectomy and evacuation of abscess, inflammation was gradually improved. She returned to normal except for slight gait disturbance. Spinal epidural abscess often develops rapidly after Staphyloccocus aureus infection. In our case, however, neurological deficits appeared 144 days after insertion of epidural catheter. We must remember that spinal epidural abscess is an important cause of lumbago with high fever, even several months after surgical or catheterial intervention to the spine, for immunocompromised patients with diabetes or neoplasm.

Aged↗
PubMed1999

Brucellar spinal epidural abscess.

Spinal epidural abscesses account for approximately one of every 10, 000 admissions to tertiary hospitals. The midthoracic vertebrae are the most frequently affected, whilst the cervical spine is involved in fewer patients. Staphylococcus aureus is identified as the cause in most cases of epidural abscess; other bacteria responsible include Gram-negative bacteria, Streptococcus species and Brucella species. We report the case of a patient with cervical spondylodiscitis at level C4-C5 and an epidural abscess which was compressing the spinal cord and the retropharyngeal space. The previous symptoms of brucellosis were atypical. We discuss the clinical manifestations, diagnosis, treatment and prognosis of the case.

Abscess↗
PubMed1993

[Stellate ganglion blocks as the suspected route of infection in a case of cervical epidural abscess].

Spinal epidural abscess is a comparatively rare disease. Its prognosis reportedly depends on degree and duration of the neurological symptoms before the treatment. Thus, the importance of early diagnosis and prompt surgical treatment has been emphasized repeatedly. In the case reported here stellate ganglion blocks were considered to be involved in the etiology of a cervical epidural abscess. The 47-year old woman complained of tinnitus and vertigo and repeatedly underwent stellate ganglion blocks over a period of 10 months. In August, 1991, the patient complained of back pain and developed fever. A few days later she noticed motor weakness and sensory disturbances in the legs. Ten days after the onset of these neurological symptoms she complained of rapidly progressive tetraplegia and was referred to this hospital for admission. On admission, she was fully conscious but febrile. Neurologically, she presented tetraplegia, hypesthesia below level of C7 and slight cervical rigidity. Bladder and bowel dysfunction were also observed. MRI examination showed an epidural mass behind vertebral bodies C6-7 compressing the spinal cord. Antibiotic therapy was initiated immediately and emergency surgical decompression was performed through an anterior approach. Intraoperative findings showed a discitis and yellowish liquid pus in the epidural space. Culture of the pus revealed staphylococcus aureus. In this case repeated stellate ganglion blocks before onset of the symptoms were the suspected route of infection. Postoperative MR images confirmed satisfactory decompression of the spinal cord and motor power was gradually recovered after surgery. Approximately 4 months after surgery she could walk independently. Cervical epidural abscess has been rarely reported as a complication of stellate ganglion block.(ABSTRACT TRUNCATED AT 250 WORDS)

Abscess↗
PubMedDate not supplied

Ensuring prompt diagnosis and treatment of epidural abscess.

An epidural abscess, defined as a collection of pus between the dura mater of the spinal cord and the vertebral canal (Mosby, 2002), is a rare complication of epidural analgesia. Prompt diagnosis and treatment are essential to a good outcome. If left untreated, an epidural abscess can result in permanent paralysis and incontinence. It is essential that nurses caring for patients receiving epidural analgesia are aware of this potential risk.

Analgesia, Epidural↗
PubMed2001

[Successful medical treatment of spinal epidural abscess].

Spinal epidural abscess is rare in children. We describe the case of a 5 year old girl with vertebral osteomyelitis and spinal epidural abscess. Diagnosis was made by magnetic resonance imaging and scintigraphic study with HMDP99Tc. Treatment with intravenous cefotaxime (200mg/kg/day) and cloxacillin (200mg/kg/day) for 15 days followed by oral cloxacillin (100mg/kg/day) for a further 15 days produced a satisfactory clinical outcome.

Administration, Oral↗
PubMed1999

[Epidural abscess following a lumbar epidural catheter for mobilization of the knee].

We report on a case of a lumbar epidural abscess with staphylococcus aureus following a catheter epidural anaesthesia in a previously healthy and not immunosuppressed 34-year-old female. The indication for the epidural anaesthesia was mobilization of the right knee following arthrotomy due to chronic synovitis. On postoperative day 7 the patient experienced lumbar pain, headache and meningism. Magnetic resonance imaging revealed an epidural abscess at the height of the 3rd and 4th lumbar vertebrae. A right-sided intralaminar fenestration with debridement and drainage of the abscess was carried out immediately after confirmation of the diagnosis. The patient was discharged from hospital on postoperative day 21 without any neurological sequelae. This is another addition to the published cases of epidural abscess following a epidural technique. It underlines the need for a proper aseptic technique, to abandon frequent changes of bacterial filters, daily examination of the entry site of the catheter and strategies for close and continuous monitoring of patients following epidural anaesthesia.

Abscess↗
PubMed2001

Management of an epidural abscess after continuous epidural catheter infusion.

OBJECTIVE: To increase awareness of the possibility of epidural infection after continuous epidural infusion. Outline the salient diagnostic features of epidural infection. Outline a strategy to manage epidural infection and minimize morbidity. SETTING: Academic multidisciplinary pain clinic. PATIENT: A patient with a left knee meniscal tear with a history of Chronic Regional Pain Syndrome Type I (CRPS I) of the left foot. INTERVENTIONS: Attempted control of CRPS I symptoms with a tunnelled epidural catheter infusion. RESULTS AND CONCLUSIONS: The patient developed an epidural abscess diagnosed on the 11th postoperative day. The catheter was removed and the patient was treated successfully with intravenous antibiotics.

Journal Article↗
PubMed1993

[Six cases of epidural abscess probably caused by epidural block and examination by gadolinium-MRI imaging].

We treated six cases of epidural abscess caused probably by epidural block. Three patients were given only chemotherapy and the other three underwent surgical treatment. Four patients were cured completely, but bilateral paresis in the lower limbs persisted in two patients. The symptoms at onset, laboratory findings, imaging findings including MRI and CT, treatment methods and prognosis were reported. Accelerated blood sedimentation rate, positive CRP results and abnormal findings at the site of the catheter insertion appeared to be important initial signs for the early discovery of epidural abscesses. The route of infection, selection of treatment methods, methods of prevention and examination by Gadolinium-MRI imaging were also discussed.

Abscess↗
PubMed2002

Epidural abscess complicating insertion of epidural catheters.

We present three cases of epidural abscess, all in patients in whom an epidural catheter had been inserted for postoperative pain management. In all three cases the infecting organism was Staphylococcus aureus and two patients had diabetes. The diagnosis was made within 3 days of epidural catheter removal in two cases, but in one the abscess did not present until after the patient had been discharged from hospital. We have retrospectively calculated the incidence of epidural abscess in our hospital over the 5-yr period 1993-98 to be 1 in 800 (0.12%). We emphasize the importance of using techniques that minimize the risk of bacterial contamination during both catheter placement and the management of infusion, and seek to raise awareness of this relatively rare but significant condition.

Aged↗
PubMed1985

Spinal epidural abscess.

Spinal epidural abscess is an uncommon and serious infection resulting from direct extension of a local process or hematogenous spread from an antecedent or ongoing distant focus of infection. The findings of spinal ache, tenderness, and fever should suggest the diagnosis, and the appearance of weakness and loss of sensation below the area of pain should be considered as the strongest possible clinical confirmation. In cases in which this constellation of findings occurs, rapid evaluation and immediate surgical decompression and drainage offer the patient a possible successful functional recovery. Even in recent series, permanent paralysis and death occur with unfortunate frequency, and these have usually been related to delay in diagnosis and definitive surgical therapy.

Abscess↗
PubMed1999

[Diagnosis and treatment of spinal epidural abscess].

Spinal epidural I abscess is an uncommon disease. The medical literature emphasizes the importance of its timely recognition and treatment. Three patients admitted in our hospital are presented. None of them was diagnosed on ambulatory bases. All of them were admitted because of spinal ache and two of them also had fever. Magnetic resonance imaging yielded the correct diagnosis in all cases and was very effective in delineating the extent of the lesion. We used antimicrobial therapy directed against the bacteria identified by cultures as well as surgical drainage in all cases. The three patients had a good outcome and no neurologic sequela. Early recognition, proper microbiologic diagnosis and surgical drainage are the main criteria for the current management of spinal epidural abscess.

Abscess↗
PubMed2006

Epidural abscesses.

Until recently epidural abscess was considered a rare, almost theoretical, complication of central nerve block, but anecdotal reports suggest that this is no longer the case. Thus a review of the risk factors, pathogenesis, clinical features and outcome of this condition is appropriate, the primary aim being to make recommendations on best anaesthetic practice to minimize the risk of this serious complication. A search of EMBASE(c), PUBMED(c) and MEDLINE(c) databases from 1966 to September 2004 was performed using several strategies, supplemented by reference list screening. Spontaneous epidural abscess is rare, accounting for 0.2-1.2 cases per 10,000 hospital admissions per year. Estimates of the incidence after central nerve block vary from 1:1,000 to 1:100,000. Risk factors (compromised immunity, spinal column disruption, source of infection) are present in the majority of patients, whether the condition is spontaneous or associated with central nerve block. Presentation is vague, fever and back pain usually preceding neurological deficit. Diagnosis requires a high index of suspicion and modern imaging techniques. Treatment involves early surgical drainage to prevent permanent deficit and high dose parenteral antibiotics chosen with bacteriological advice. Primary prevention depends on proper use of full aseptic precautions. Epidural abscess can be a catastrophic consequence of central nerve block. Early diagnosis will minimize permanent damage, but primary prevention should be the aim. There is a need for a large survey to indicate the true incidence to better inform the risk-benefit ratio for central nerve block.

Anesthesia, Epidural↗
PubMed2006

Two cases of spinal epidural abscess with granulation tissue associated with epidural catheterization.

Two cases of spinal epidural abscess are reported whose abscesses became granulated after epidural catheterization. Although emergency surgical intervention was performed almost within 24 h after the diagnosis of epidural abscess in case 1, the patient revealed a poor outcome. After laminoplasty, case 2 received lumbar epidural catheterization, and he had a complete recovery. The abscesses were recognized to spread around the catheter insertion site of the operative procedure in both cases, and MRI in case 2 showed the connection between the epidural abscess and the interspinous space where the catheter had been inserted. Methicillin-sensitive Staphylococcus aureus (MSSA) was identified at the operative field in both cases. Also, MSSA was identified at the subcutaneous abscess around the catheter in case 1 and at the catheter tip in case 2. Those findings suggest the midpoint of the abscess is the puncture site and that MSSA is found in or around the catheter. Infection at epidural catheterization seems to be caused by catheter insertion or skin contamination after catheterization. As those catheterizations were completed in the outpatient theater, we conclude that epidural catheterization should be performed in the operating room or with a restricted aseptic technique.

Abscess↗