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Results for “Epidural Abscess”

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At least 379 records · Page 21Linked to original sources
PubMed1995

Spinal epidural abscess complicating tuberculous spondylitis.

We report the case of a patient with tuberculous L1-L2 spondylo-discitis complicated by a spinal epidural abscess which extended anteriorly to the cord up to the low cervical level. Mild signs and symptoms of spinal cord involvement improved with antituberculous therapy; however, after seven months of therapy, the MRI appearance of the abscess findings was unchanged. An attempt at surgical decompression and drainage of the abscess was unsuccessful because of the presence of dense scar tissue.

Abscess↗
PubMed2000

Spondylodiscitis and epidural abscess due to Candida albicans.

A 32-year-old woman, addicted to heroin, presented with a dorsal spondylodiscitis due to Candida albicans associated with epidural abscess. Antimycotic treatment was successful, and no neurosurgical decompression was necessary. To our knowledge, this is the first case of documented epidural involvement in candidal spondylodiscitis. The diagnosis of candidal spondylodiscitis should be considered in cases of para- or tetraplegia occurring in intravenous drug abusers.

Adult↗
PubMed2004

The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess.

Previous reports have recommended the use of a "classic triad" of fever, spine pain, and neurologic deficits to diagnose spinal epidural abscess (SEA); however, the prognosis for complete recovery is poor once these deficits are present. This retrospective case-control study investigates the impact of diagnostic delays on outcome and explores the use of risk factor screening for early identification of SEA in a population of ED patients. Inpatients with a discharge diagnosis of SEA and a related ED visit before the admission were identified over a 10-year time period. In addition, a pool of ED patients presenting with a chief complaint of spine pain was generated; controls were hand-matched 2:1 to each SEA patient based on age and gender. Data regarding demographics, presence of risk factors, physical examination findings, laboratory and radiographic results, and clinical outcome were abstracted from medical records and entered into a database for further analysis. Patients with SEA were compared to matched controls with regard to the prevalence of risk factors and the "classic triad." We also explored the impact on outcome of diagnostic delays, defined as either: 1) multiple ED visits before diagnosis, or 2) admission without a diagnosis of SEA and >24 h to a definitive study. A total of 63 SEA patients were hand-matched to 126 controls with spine pain. Diagnostic delays were present in 75% of SEA patients. Residual motor weakness was present in 45% of these patients vs. only 13% of patients without diagnostic delays (odds ratio 5.65, 95% C.I. 1.15-27.71, p < 0.05). The "classic triad" of spine pain, fever, and neurologic abnormalities was present in 13% of SEA patients and 1% of controls during the initial visit (p < 0.01); one or more risk factors were present in 98% of SEA patients and 21% of controls (p < 0.01). The erythrocyte sedimentation rate (ESR) was more sensitive and specific than total white blood cell (WBC) count as a screen for SEA. In conclusion, diagnostic delays are common in patients with SEA, often leading to irreversible neurologic deficits. The use of risk factor assessment is more sensitive than the use of the classic diagnostic triad to screen ED patients with spine pain for SEA. The ESR may be a useful screening test before magnetic resonance imaging in selected patients.

Adult↗
PubMed2003

Melioidosis presenting as spinal epidural abscess.

Central nervous system melioidosis is an unusual infection in humans. This article reports a case of melioidosis presenting as an acute spinal epidural abscess. A discussion of this case and its management together with a brief review of melioidosis of the central nervous system is presented.

Acute Disease↗
PubMed2003

Intracranial suppuration: a clinical comparison of subdural empyemas and epidural abscesses.

BACKGROUND: We compared the clinical features and therapeutic outcomes of intracranial suppurations (IEs) caused by sub-dural empyema (SDEs) and epidural abscesses (EAs). METHODS: Twenty-four patients with IE were retrospectively identified at our institution over a period of 14 years. Therapeutic outcomes at 6 months were determined using the Glasgow Outcome Scale. RESULTS: Among them, 15 had SDE and nine had EA with or without SDE. The three most frequently encountered clinical features Included fever (79%), disturbed consciousness(58%), and seizures (54%). Postneurosurgical or posttraumatic states (42%) and complication after meningitis (38%) were the two most common modes of infection. The overall mortality rate was 8% (2/24). However, if mortality and severe neurologic sequelae were included in the poor outcome group, then 29% (7/24) of our patients would be considered treatment failures. CONCLUSION: In this study, SDE commonly arose following bacterial meningitis with a more fulminant course, but no deaths occurred. In contrast, EA commonly has a more Indolent course and is postoperatively or post-traumatically related, and therefore may have a higher mortality rate based on primary brain pathophysiology alone. Inpatients with meningitis or who undergo postneurosurgical procedures and develop fever, progressive disturbed consciousness, seizures, and focal neurologic signs, immediate neuroimaging studies should be per-formed to determine whether IE is present. Early surgical drainage and aggressive antimicrobial therapy are necessary.

Adolescent↗
PubMed1979

Spinal epidural abscess in patients on maintenance haemodialysis (a presentation of two cases).

Two cases of spinal epidural abscess in patients on maintenance haemodialysis, one of them secondary to infection in an arteriovenous fistula, are described. Both cases presented the typical symptoms known from the literature, but were diagnosed too late to prevent neurological sequelae. The condition is rare, but dialysis patients are to be considered a risk group because of their reduced immunocapacity and increased hazard of infection, especially fistula and shunt infections. Awareness of this, and knowledge of its early symptoms are required for timely neurosurgical intervention and thus prevention of irreversible spinal cord damage.

Abscess↗
PubMed1996

Human skin flora as a potential source of epidural abscess.

BACKGROUND: The mechanism of epidural infection associated with epidural block is not clearly understood. Resident organisms in skin specimens were studied after skin was prepared with disinfectants. METHODS: Sixty-nine paired skin specimens were excised at incisional sites after skin disinfection with 10% povidone-iodine (10% PVP-I) or 0.5% chlorhexidine in 80% ethanol (0.5% CHE) from 60 patients having back surgery. One of the specimen pairs was placed in 10 ml brain-heart infusion broth and incubated in air at 37 degrees C for 96 h. The other specimen was sectioned at 3 microns and prepared with Gram's stain for examination with the microscope. RESULTS: Thirteen gram-positive staphylococcal species (Staphylococcus epidermidis, 69.2%; S. hyicus, 15.4%; and S. capitis, 15.4%) were isolated from cultures. The isolates were found in a significantly greater proportion of the skin specimens disinfected with 10% PVP-I than in those disinfected with 0.5% CHE (11 of 34 cultures [32.4%] vs. 2 of 35 cultures [5.7%]; P < 0.01). Many gram-positive cocci were observed with the microscope in 4 (11.8%) and 5 (14.3%) of 34 and 35 skin specimens disinfected with 10% PVP-I and 0.5% CHE, respectively. The cocci formed a dense colony in each follicle and in the stratum corneum. No organism was present in any of 17,584 sweat glands examined. CONCLUSIONS: In a large proportion of patients, isolation of viable organisms from excised skin specimens after disinfection with 10% PVP-I suggests that contamination of the epidural space by the skin flora may be a potential mechanism of epidural infection associated with epidural block.

Abscess↗
PubMed2005

Disseminated cat scratch disease with vertebral osteomyelitis and epidural abscess.

A 5-year-old boy with cat scratch disease presented with fever of unknown origin and osteomyelitis of the thoracic spine and epidural abscess. He did not have localizing signs or symptoms. Computed tomography of the abdomen, which was initially negative, showed hepatosplenic disease. Cat scratch disease has variable systemic presentations and should be included in the differential diagnosis of fever of unknown origin if an epidemiologic risk factor is present.

Animals↗
PubMed2002

Spinal epidural abscesses: clinical manifestations, prognostic factors, and outcomes.

OBJECTIVE: This study was performed to evaluate the clinical manifestations and prognostic factors for outcomes among patients with nontuberculous spinal epidural abscesses. METHODS: The records and magnetic resonance imaging/computed tomographic results for patients treated between 1994 and 2000 were retrospectively evaluated. Outcomes were assessed after 11 months, using scores ranging from 0 (dead) to 4 (no neurological deficits). RESULTS: All 25 patients (mean age, 62 yr) underwent surgery and subsequently received antibiotics. Back/neck pain (72% of patients), leukocytosis (64%), fever (60%), and motor deficits (56%) were the most common symptoms at admission. Outcomes were assessed as poor for 40% of the patients and as good (no deficit or independently ambulatory) for 60%. Low leg muscle strength grades (r = 0.68, P < 0.001) and high white blood cell (WBC) counts (r = -0.56, P = 0.006) at admission were significantly correlated with low outcome scores. From the time of admission until 14 days after surgery, the poor-outcome group exhibited significantly (P < 0.005) higher WBC counts, compared with the good-outcome group. The same was true for C-reactive protein levels, with the exception that no differences between groups were observed until 8 days after surgery. Factors such as cervicothoracic abscess locations (P = 0.041), lower limb motor deficits (P = 0.005), complete paralysis (P = 0.005), and WBC counts of more than 14,000 cells/microl (P = 0.049) at admission were observed to be prognostic for poor outcomes. CONCLUSION: Surgical decompression combined with antimicrobial therapy remains the recommended treatment. In addition to abscess locations and motor deficits, inflammatory markers such as WBC counts and C-reactive protein levels are prognostic for outcomes.

Adult↗
PubMed2005

Nocardial epidural abscess of the thoracic spinal cord and review of the literature.

Nocardia is a potential cause of opportunistic infection in organ-transplant recipients. We report an epidural abscess causing acute paraparesis in a patient with a rejected renal transplant and chronic liver disease. Early drainage and treatment with imipenem and trimethoprim-sulfamethoxasole improved the patient's neurologic status.

Anti-Bacterial Agents↗
PubMedDate not supplied

Update on spinal epidural abscess: 35 cases and review of the literature.

Thirty-five cases of spinal epidural abscess were evaluated retrospectively and compared with 153 cases reported in the literature. As in other series, Staphylococcus aureus was the major pathogen. Patients with acute abscesses had fever, leukocytosis, and purulence at surgery. Patients with chronic abscesses had less fever and leukocytosis, more granulation tissue at surgery, and a greater delay in diagnosis but retained the potential for rapid neurologic deterioration. In contrast to other studies, abscesses in both the lumbar and anterior spinal compartments and patients with specific sources of infection occurred with greater frequency. Myelography was the diagnostic method of choice. Only four of nine patients had diagnostic computed tomography. Earlier diagnosis and treatment led to a significant improvement in outcome. Both steroid administration and greater neurologic impairment adversely affected outcome. Neurologic improvement following surgery was dependent on the duration of the deficit. A combination of antibiotics and surgical drainage remains the treatment of choice.

Abscess↗
PubMed2000

Enlargement of a chronic aseptic lumbar epidural abscess by intraspinal injections--a rare cause of progressive paraparesis.

The frequent use of invasive procedures at the spinal cord such as epidural injections has led to an increased incidence of iatrogenic abscesses. We report the case of a patient who suffered from low back pain. During epidural lumbar injections of steroids the patient developed severe radicular symptoms, resulting in severe paraparesis. We demonstrate the rare cause of this progressive deterioration, being a combination of a preexisting chronic aseptic epidural abscess and an iatrogenic enlargement by repeated epidural injections. MR-Scans demonstrated a mass lesion at the L4/5 vertebral level, which was surgically removed. Histological evaluation revealed the presence of a chronic aseptic spinal epidural abscess with acute bleedings. Histology and MR-Data disclosed multiple deposits of the applied drug within the abscess and in the surrounding paravertebral soft tissue. The authors prove that the cause of the neurological deterioration was due to epidural injections into a preexisting lumbar chronic aseptic epidural abscess. Harmful and unpleasant complications may occur following epidural injections. Though we present a very rare cause of such complications, a careful monitoring of the neurological status of the patient is necessary as well as the early application of MR imaging in the case of deterioration.

Disease Progression↗
PubMed2005

Tophaceous gout of the lumbar spine mimicking infectious spondylodiscitis and epidural abscess: MR imaging findings.

We report a case of surgically proven tophaceous gout of the lumbar spine at the L5-S1 level that mimicked infectious spondylodiscitis and epidural abscess on magnetic resonance (MR) images in a 65-year-old woman. The spinal tophi were hypointense on T1-weighted images; focally and strongly hyperintense on T2-weighted images; and heterogeneously, marginally enhancing on contrast-enhanced T1-weighted images. The aim of this report is to emphasize the importance of considering this disease entity in the differential diagnosis of an epidural mass in a patient with chronic back pain.

Aged↗
PubMed1996

Cervical spine epidural abscess in a patient with no predisposing risk factors.

We report a case of cervical spine epidural abscess in a 50-year-old man with a 4-day history of neck pain but no neurologic deficits or fever. The patient had no predisposing risk factors such as recent spinal surgery, trauma, instrumentation, distal site of infection, immunosuppression, diabetes, or i.v. drug abuse. A review of the literature follows.

Abscess↗