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PubMed2002

Spinal epidural abscess: a diagnostic challenge.

Epidural abscess of the spinal column is a rare condition that can be fatal if left untreated. Risk factors for epidural abscess include immunocompromised states such as diabetes mellitus, alcoholism, cancer, and acquired immunodeficiency syndrome, as well as spinal procedures including epidural anesthesia and spinal surgery. The signs and symptoms of epidural abscess are nonspecific and can range from low back pain to sepsis. The treatment of choice in most patients is surgical decompression followed by four to six weeks of antibiotic therapy. Nonsurgical treatment may be appropriate in selected patients. The most common causative organism in spinal epidural abscess is Staphylococcus aureus. Spinal epidural abscess involving actinomycosis is rare.

Actinomycetales Infections↗
PubMed1979

Epidural abscess: a hazard of spinal epidural anaesthesia.

Two cases of spinal epidural abscess following prolonged epidural anaesthesia are presented. The clinical features included fever, malaise, and signs of nerve root compression; backache was not marked. Prompt surgical drainage and appropriate antibiotics are required to avoid the costly sequelae of bladder and leg paralysis from spinal cord compression. Both infections were caused by bacterial contamination of catheter, and although this complication is uncommon, it emphasizes that strict asepsis is essential during continuous epidural anaesthesia.

Abscess↗
PubMed1990

Acute spinal epidural abscess.

Acute spinal epidural abscess is an uncommon disease. Recommended management has been mainly surgical. We recently treated three cases within 4 weeks. Lowered immune resistance played a role in two of the cases. We suggest that acquired immunodeficiency syndrome will increase the incidence of this uncommon entity and advise that acute spinal epidural abscess can be successfully treated by nonsurgical means in some cases.

Abscess↗
PubMed2000

Acute neurologic deterioration following lumbar puncture in an epidural abscess occurring 14 months after epidural catheter placement.

We report the case of a 19-year-old girl admitted to the hospital with a 2-month history of back pain and a 1-week history of severe weakness, who underwent a diagnostic lumbar puncture which was swiftly followed by acute neurologic deterioration requiring ventilation. She was subsequently shown to have an epidural abscess extending from the second cervical to the fifth lumbar vertebrae. She had received uneventful epidural analgesia for childbirth 14 months previously. The case is unusual in both the acute deterioration following lumbar puncture, and also in the length of time from epidural siting to abscess formation, if this were indeed the source of the infection.

Adult↗
PubMed2004

Spinal epidural abscess--a rare complication after epidural analgesia for labour and delivery.

We report a case of spinal epidural abscess formation after short-term epidural catheter placement for analgesia during labour and delivery. The patient was previously healthy and did not have any predisposing factors. Increasing back pain was the only complaint. A contrast-enhanced CT study on day 5 was inconclusive. Magnetic resonance imaging was performed and showed a large triangular-shaped abscess with adjacent inflammation of the paravertebral muscles. One day later, the patient developed a sensory deficit in the left lower limb. The neurological deficit completely resolved after surgical decompression and debridement, which was followed by antibiotic treatment.

Adult↗
PubMed1997

Epidural abscess after combined spinal-epidural block.

PURPOSE: We report the first case of abscess formation after combined spinal-epidural block (CSE). Penetration of the dura in CSE may constitute an additional risk of subarachnoid spread of bacteria when post-puncture epidural infection is present. CLINICAL FEATURES: The combination of a spinal and a continuous epidural block (CSE) using a needle through needle technique was used in a 72-yr-old man for reconstructive vascular surgery of the lower limb. On the fourth postoperative day the patient demonstrated back pain, fever, and exudation of pus from the CSE-puncture site. An epidural abscess was diagnosed by magnetic resonance imaging and subsequently an emergency hemiaminectomy was performed. Physical examination and surgery did not show evidence of bacterial spread into the subarachnoid space. CONCLUSION: Epidural abscess formation after CSE may increase the risk of bacterial spread into the subarachnoid space. In this case spontaneous exudation and surgical drainage of abscess material may have prevented intrathecal infection. Rapid diagnosis and treatment of an epidural abscess appears particularly essential after CSE to prevent neurological sequelae.

Abscess↗
PubMed2007

[Spinal epidural abscess after long-term epidural catheterization].

This case report describes a 63-year-old male patient with considerably impaired postoperative wound healing in the region of the lower extremities. After initial drug therapy for the pain was ineffectual, the patient was treated repeatedly through an epidural catheter. In the further course, an extensive spinal epidural abscess was diagnosed as an incidental finding without neurological symptoms. After taking into consideration the patient's age and the risk factors present as well as inclusion of the subspecialties involved for an interdisciplinary assessment, the patient was successfully treated with a conservative approach. Our contribution concludes with a detailed discussion and comparison of the literature.

Analgesia, Epidural↗
PubMed1999

Brain Abscess, Subdural Empyema, and Intracranial Epidural Abscess.

Brain abscess, subdural empyema, and intracranial epidural abscess are three of the most commonly encountered focal suppurative processes of the central nervous system. A great deal has been known about the epidemiology and pathogenesis of these entities for quite some time, but until recent years the associated morbidity and mortality remained very high. New imaging techniques have allowed for more rapid detection and more precise localization of these lesions for surgical drainage. Empiric antimicrobial regimens that are effective within the abscess environment and that are directed against the most likely pathogens have also contributed to the improved outcomes seen in the current literature. This article will discuss some of the more recent advances in the diagnosis and treatment of these suppurative lesions within the central nervous system.

Journal Article↗
PubMedDate not supplied

A report of Froin's syndrome in five ovine thoracolumbar epidural abscess cases.

An epidural abscess involving the thoracolumbar spinal cord was considered the probable cause of pelvic limb paresis in those sheep where analysis of lumbar cerebrospinal fluid (CSF) samples revealed a significant increase in protein concentration (P less than 0.05) and some increase in total white blood cell concentration and neutrophil percentage. There was no significant increase in protein concentration in the corresponding cisternal samples. This phenomenon caused by blockage to CSF flow is not dissimilar to that of Froin's syndrome in man which has been reported as a result of localized spinal meningitis (Brain, 1985).

Abscess↗
PubMed2002

[Epidural abscess and regional anesthesia].

An epidural abscess is a rare lesion whose consequences can cause high morbi-mortality, particularly in obstetrics, where it occurs in young, healthy patients. With increased use of regional anesthesia, the incidence of epidural abscess will increase. We therefore review the risk factors, most common etiology and clinical signs, which may be non-specific but are nevertheless suggestive. We also review available diagnostic methods. It may be difficult to distinguish epidural abscess from other causes of medullar compression, but prompt diagnosis is essential so that emergency surgical repair can proceed and neurological recovery will be as early and complete as possible. Appropriate antibiotic therapy should be aggressive. Basic aseptic measures are critical for preventing infection through epidural needles, as the presence of infection at the moment of puncture facilitates greater susceptibility to epidural abscess.

Analgesia, Epidural↗
PubMed1997

Spinal epidural abscess associated with the use of temporary epidural catheters: report of two cases and review.

Spinal epidural abscess has rarely been associated with the use of epidural catheters. We describe two patients with epidural abscesses that occurred in relation to the use of temporary epidural catheters; a literature review yielded 20 additional well-described cases. The mean age of these 22 patients was 49.9 years, the median duration of epidural catheter use was 3 days, and the median time to onset of clinical symptoms after catheter placement was 5 days. The majority of patients (63.6%) had major neurological deficits, and 22.7% also had concomitant meningitis. Staphylococcus aureus was the predominant pathogen. Despite antibiotic therapy and drainage procedures, 38% of the patients continued to have neurological deficits. These unusual but serious complications of temporary epidural catheter use require efficient and accurate diagnostic evaluation, as they can be substantial.

Abscess↗
PubMed2005

Klebsiella pneumoniae liver abscess associated with septic spinal epidural abscess.

A 56-year-old Japanese man with hypertension presented with a 10 days history of high fever, right and left upper quadrant tenderness. An abdominal ultrasonography and computerized tomographic scan revealed a large collection in the right lobe of the liver that was consistent with an abscess. A drainage catheter was placed and purulent fluid was drained. Cultures of the fluid and blood were positive for a strain of ampicillin-resistant Klebsiella pneumoniae. Six days after admission, paraplegia and urinary retention were found. On the neurological examination, deep tendon reflexes of the lower extremities were absent bilaterally. Magnetic resonance imaging scan detected thoracic spinal epidural abscess and paraspinal abscess. He received the emergent decompressive laminectomy. Culture of surgical specimen grew ampicillin-resistant K. pneumoniae. The patient was treated with biapenem intravenously. Thereafter, clinical symptoms improved gradually and he was removed to the professional hospital to continue rehabilitation for gait disturbance on hospital day 147.

Journal Article↗
PubMed2005

Epidural abscess in an obstetric patient with patient-controlled epidural analgesia--a case report.

We present the case of a 37-year-old pregnant woman who underwent a cesarean section due to previous cesarean delivery. Spinal anesthesia was performed at the L2-3 intervertebral space with an epidural catheter inserted at L1-2 for postoperative patient-controlled epidural analgesia. When the epidural catheter was removed on day three, an area of redness round the entry point was noted and the patient complained of low back pain, but was discharged from hospital. Later the same day, she felt backache so severe that she was unable to stand up or bend her body. She called for help and was sent to our emergency room. Physicians noted a small amount of discharge from the insertion site, and the body temperature was elevated to 38 degrees C. An anesthesiologist and an infectious disease specialist were consulted, and an epidural abscess was suspected. Urgent magnetic resonance imaging revealed an epidural abscess at L1-2. After five days of unsuccessful treatment with oxacillin, a 28-day course of vancomycin, followed by two months of oral fusidic acid, resulted in complete remission of the epidural abscess. The patient has remained free of neurologic deficit.

Adult↗
PubMed1997

Epidural abscess in association with obstetric epidural analgesia.

A 31-year-old woman gravida 4 para 2 who had received epidural analgesia during labour (duration of catheterization 6.5 h) was readmitted 8 days later with a complaint of flu-like symptoms, severe backache and numbness of her thighs. She had a sensory deficit from T4 to L1 and was unable to stand without support. The severe backache prevented adequate assessment of motor function. An MRI scan suggested an epidural mass. Surgical decompression by hemilaminectomy was carried out within 24 h of admission and revealed an epidural abscess. Culture of the drained pus grew Streptococcus pneumoniae. She made a complete recovery and was discharged home on the tenth day. This case illustrates the problem of diagnosing serious postnatal problems that arise following the now fashionable early discharge from hospital.

Journal Article↗