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PubMed2006

Septic arthritis of the atlantoaxial joint: case report.

Bacterial epidural abscess formation of cervical spine was rarely seen and all these cases were associated with osteomyelitis of the odontoid process. To the author's knowledge, only 1 case of septic arthritis of the C1-C2 lateral facet joint has been reported in the English literature. A 76-year-old woman presented with progressive neck pain and stiffness in the left side of her neck with fever. Coronal computed tomography clearly demonstrated destructive change of the atlantoaxial joint. Contrast magnetic resonance imaging demonstrated infection of the atlantoaxial joint resulting in epidural abscess formation. Because of lack of neurologic deficit, we treated her with halo-fixation together with appropriate antibiotics administration. The patient was successfully treated with antibiotics and immobilization. Septic arthritis of the lateral atlantoaxial joint should be added to the differential diagnosis of severe neck pain with fever, although it is very rare clinical entity. Early analysis of computerized tomography and magnetic resonance imaging although maintaining a high suspicion for this disease is mandatory to avoid delayed diagnosis and subsequent morbidity.

Aged↗
PubMed1990

Epidural spinal abscesses.

Fifteen cases of peridural empyemas are reported. 12 patients reported with motor dysfunction of the lower extremities and pain radiating from the spine. In one case, localized pain of the spine was discovered and in two cases there were no signs of spinal or radiating pain. Treatment in all cases was laminectomy and systemic antibiotic administration. Microbiological analysis showed staphylococcus aureus in 11 cases. 9 patients recovered with no neurological defects, two had major improvement of the paresis, and one died. Three patients with paraplegia recovered from the primary infection.

Back Pain↗
PubMed2001

Protean infectious types and frequent association with neurosurgical procedures in adult Serratia marcescens CNS infections: report of two cases and review of the literature.

Serratia marcescens is a rare pathogen of adult central nervous system (CNS) infection. We report on the clinical features and therapeutic outcomes of two adult patients with such infections. The clinical characteristics of 13 other reported adult cases are also included for analysis. The 15 cases were nine males and six females, aged 19-83 years, in whom, underlying post-neurosurgical states and ear operation were noted in 93% (14/15). Fever and conscious disturbance were the most common clinical manifestations of these 15 cases, followed by hydrocephalus, seizures, and wound infections. The manifestation types were protean, including meningitis and focal suppurations such as brain abscess, cranial and spinal epidural abscess, cranial subdural abscess, and infected lumbar pseudomeningocele. One case of S. marcescens CNS infection was diagnosed postmortem; the other 14 were diagnosed by the positive culture from CSF or pus. Antibiotic therapy with or without neurosurgical intervention was the management strategy in 14/15 cases. The therapeutic results showed a high mortality rate.

Adult↗
PubMed2005

Treatment of chronic frontal sinus disease with the galeal-frontalis flap: a long-term follow-up.

BACKGROUND: Management of benign chronic frontal sinus disease is difficult. Patients are frequently seen by multiple specialties for medical treatment and endonasal procedures before they seek or require definitive treatment with frontal sinus obliteration. The progression of the disease may lead to serious or life-threatening conditions such as local bone destruction, periorbital abscess, osteomyelitis, meningitis, cranial epidural abscess, or septicemia. This study presents the use of the galeal-frontalis myofascial flap as part of the treatment of this disease. METHODS: Thirty-one patients with chronic frontal sinus disease requiring obliteration were included in this study; all were approached through a coronal incision. The anterior wall of the frontal sinus was removed and the frontal sinus disease was evacuated. The sinus mucosa was completely removed, and the frontal sinus and nasofrontal duct were totally obliterated with either a unilateral flap or a bilateral galeal-frontalis flap. RESULTS: All patients had failed medical therapy and many had failed endonasal and endoscopic procedures. The mean follow-up was 43.6 months (range, 1 to 125 months). There were two early complications, a seroma and a hematoma. Sinus infection recurred in one patient 3 months postoperatively. The recurrent infection was treated in the same manner, using the available and viable galeal-frontalis flap to obliterate the frontal sinus, with no recurrence after 40 months. CONCLUSIONS: The galeal-frontalis flap has been investigated by angiography and is based on the supratrochlear and supraorbital vessels. Its location and vascularity make it reliable and effective for frontal sinus obliteration. In the head and neck area and elsewhere, filling defects with vascularized tissue prevents infection. A further advantage is that any residual defects are usually well tolerated by patients, and those requesting correction can be easily accommodated. The risks and complications from using exogenous materials and from performing secondary procedures for graft harvest are avoided. Considering that most patients presented with complications from advanced disease and that after one revision no patients have had recurrence of disease, obliterative treatment with the galeal-frontalis myofascial flap should be contemplated earlier in treating patients with chronic frontal sinus disease.

Adolescent↗
PubMed1992

Staphylococcal infection of the odontoid peg.

An epidural abscess secondary to osteomyelitis of the odontoid peg produced a sudden left-sided weakness. Appropriate antibiotics, transoral evacuation of the pus and subsequent posterior atlanto-axial fusion were associated with a full recovery.

Abscess↗
PubMed2002

[New technologies in the surgical treatment of tuberculous spondylitis].

The paper deals with surgical treatment in 452 patients with tuberculous spondylitis. The process involved the cervical, thoracic, thoracolumbar, and lumbar parts in 40 (8.8%), 185 (41.0%), 75 (16.8%), and 11 (2.5%) cases, respectively. The active process was found in 125 (27.6%) patients, its loss was detected in 131 (29.1%) cases; the process abated in 196 (43.3%) patients. There were its complicated forms in 341 (75.4%) patients, para- and prevertebral abscesses in 183 (40.4%), epidural abscesses in 26 (5.6%), pareses and paralyses in 71 (15.7%), fistulas in 38 (8.4%), and membranous symptoms in 23 (5.1%). The diagnosis of tuberculous spondylitis was established up to month 3, in 109 (24.1%) patients, up to month 6 in 208 (46.0%), at months 9-12 in 74 (16.4%), at month 12-18 in 61 (13.5%). The concomitant tuberculous involvement of the lung, pleura, kidneys, joints, lymph nodes, and genitals was observed in 139 (30.7%) patients. The resistance of Mycobacteria tuberculosis to antituberculous drugs (streptomycin, isoniazid, and rifampicin) was detected in 139 (30.7%) patients. Of them, 40 (28.8%) patients were unresponsive to two drugs or more. This group of patients received a combined therapy with lomefloxacin and mycobutin on an individual basis. Surgery was made in all the patients; posterior approaches were applied to 44 (9.7%) patients, in 368 (81.4%) anterior approaches were applied to extrafocal apparatus fixation in combination with autograft corporadesis (n = 70), in combination of an autograft and a biocompatible implant with benemycin application (n = 298). The use of these new technologies may expand the scope of operability, reduce surgical traumaticity, initiate early (at day 7-12) rehabilitation of patients, achieve good and satisfactory clinical and functional results by months 4-8 in 81.1% of cases.

Adult↗
PubMed1989

[Infective complications of the central nervous system (CNS) in addicts to parenterally administered drugs].

Given the high rate of infection by HIV in the APAD in our country, the description of localized infectious problems in the CNS secondary to drug-addiction should always take into account opportunistic infections or tumours occurring there. The initial clinical evaluation should highlight or rule out the presence of clinical indications (specially polyadenia and oral candidiasis) which suggest a clinical condition of immunodepression. Septic embolization due to bacteremia and fungemia is common among drug-addicts, sometimes causing, although not very often in comparison with other sites, various infectious complications in the CNS (meningitis, cerebral abscess, subdural empyema or epidural abscess), "Staphylococcus aureus" being the micro-organism most frequently involved. From 1977 to 1986 the work-group for the study of infections among drug-addicts has listed 6,481 infections. Disseminated candidiasis (582 cases) and infectious endocarditis (506 cases) were the most frequent types of primary infection. Only 33 cases of infection of the CNS were observed, meningitis being the most frequent (57%). The usual empirical antibiotic treatment for meningitis is cefotaxime or cefotriaxona plus cloxacillin, and for cerebral abscess we substitute metronidazole for isoxazolic penicillin. Given the sexual habits frequently associated with APAD, neurosyphilis is suspect, since immunodepression secondary to infection by HIV causes changes in its natural behaviour. Tetanus is the most serious and uncommon infectious complication connected with drug-addiction. In our society, up to 1986 only 5 cases had been described. As for paludism, the cases detected in this country have belonged to two small outbreaks: one with four cases in Madrid with "Plasmodium vivax" and the other with three cases in Tortosa (Tarragona) with "P. falciparum".

Brain Abscess↗
PubMedDate not supplied

The foot as a primary site for distant metastatic infection.

Localized foot infection can lead to generalized sepsis under certain conditions. Two diabetic patients who suffered from infected foot ulcers, even after treatment with debridement and appropriate antibiotics, developed distant site infection. Another diabetic patient developed a distant site abscess from a chronic foot infection, for which he initially sought no medical treatment. Evaluation revealed that one patient had a psoas muscle abscess, one a renal abscess, and one an epidural abscess. All three patients were treated aggressively for their infections. One recovered fully, while two expired from septic complications associated with their illnesses. These case histories, along with the chronology of the development of sepsis from a foot infection are presented.

Abscess↗
PubMed1995

[Salmonella enteritidis multifocal infection of the central nervous system. Efficacy of new cephalosporins].

Focal central nervous system infections, as abscess and empyema, due to Salmonella species are unusual. Even more unusual is the association of cerebral abscess, subdural empyema and epidural abscess we report in the present work. This infection appeared in our patient soon after a brain astrocytoma removal and was treated with cefotaxime and gentamicin during three weeks. In spite of documented genus susceptibility to the drugs the infection relapsed in few days. It was definitely cured with ceftazidime alone for six weeks. Third-generation cephalosporins are good alternatives in uncommon infections and specially in central nervous system salmonellosis, as resistances of this genus to classical drugs are lately increasing.

Brain Abscess↗
PubMed1997

[Infectious complications after peridural obstetric anesthesia].

Infective complications after epidural anesthesia for delivery are uncommon. We reviewed 21 cases of epidural abscesses, 7 cases of meningitis and one spondylitis reported in the literature. These infections usually occurred in debilitated patients either by direct contamination at puncture or indirectly from a neighboring infection or from the blood stream. Prognosis depends on early diagnosis. The first manifestations are spinal stiffness or local pain. Signs of neurological deficiency come later at a stage when complete recovery is compromised. This emphasizes the importance of the clinical examination before delivery in search for skin or deep infections.

Abscess↗
PubMed1997

[Suppurative intracranial infections in Africa].

The purpose of this study was to review recent African literature on suppurative intracranial infection and its implications for neurosurgery. In order of decreasing frequency the main lesions are brain abscess, subdural empyema, and epidural abscess. Despite progress in diagnostic imaging and availability of antibiotic therapy, these lesions still cause disturbingly high morbidity and mortality especially in sub-Saharan Africa where diagnosis is often delayed. The male-to-female ratio was 3.6:1 and 70 to 80% of patients were under the age of 20 years. Spread from the paranasal sinus or ear was the most common mechanism of infection. Hematogenous processes accounted for 22% of cases and the origin was undetermined in 11% to 26% of cases. Staphylococcus aureus and enteric gram-negative bacilli were the most common bacteria identified but cultures were reported as sterile in 30% to 50% of cases. While ultrasonography can be useful in newborns with an open fontanelle, arteriography is often the only feasible procedure for diagnosis in Black Africa. The diagnostic modality of choice is computed tomography which allows precise mapping prior to neurosurgery. Introduction of computed tomography in some African cities has led to a decrease in mortality ranging from 4.7% to 43%. The most effective treatment is a combination of appropriate antimicrobial therapy and surgical decompression of expanding lesions. The main procedures are aspiration through burr holes and craniotomy. Use of this combined strategy requires close cooperation between the neurosurgeon, infectious disease specialist, and microbiologist. Therapeutic indications are discussed within the context of Black Africa.

Adult↗
PubMed1994

Cervical epidural spinal infection: MR imaging characteristics.

OBJECTIVE: Cervical epidural spinal infection, which includes diskitis, osteomyelitis, and/or epidural space infection, is an uncommon disease, and the MR imaging features have not been fully described. Accordingly, the objective of this study was to determine the MR imaging findings in a large series of patients with this condition, with emphasis on patients with pyogenic infection. MATERIALS AND METHODS: During a 5-1/2-year interval, 12,695 MR examinations of the spine were performed in our department. A computer search retrospectively identified 60 patients with proved epidural spinal infection; 19 (32%) had involvement of the cervical spine. Pyogenic infection was present in approximately 90% of cases. One patient had an epidural abscess without an underlying osseous abnormality. The remaining 18 patients had cervical diskitis/osteomyelitis, as well as inflammation in the epidural space. All MR examinations were performed with a 1.5-T superconducting magnet by using a combination of spin-echo, fast spin-echo, and/or gradient-echo pulse sequences; 12 patients received IV gadopentetate dimeglumine. The MR examinations were retrospectively reviewed by a neuroradiologist for multiple imaging characteristics, including extent and location of osseous abnormalities, extent and location of inflammation in the epidural space, likelihood of abscess formation, and frequency of spinal cord compromise. RESULTS: On MR images, an average of three vertebral bodies showed abnormal signal of the bone marrow. Inflammation in the epidural space extended an average of four levels and was most frequently anterior in location; MR images in six (50%) of 12 patients who received contrast material showed a large, peripherally enhancing epidural abscess. Thirteen (72%) of the 18 infections with osseous involvement occurred at or below the level of C4; the C5 and C6 levels were affected most frequently. Cord compression was identified in 14 (74%) of 19 patients; cord hyperintensity was seen in 12 (63%) of 19 patients and was well defined on T2-weighted FSE images. CONCLUSION: The results of our study show that cervical epidural spinal infection is a more aggressive disease than previously recognized. MR findings are characterized by multilevel involvement, an anterior location, and frequent abscess formation. MR evidence of isolated involvement of the epidural space, without underlying osseous abnormality, is rare. There is a predilection for infection to affect the lower cervical segments. We observed a strong association between cervical epidural spinal infection and spinal cord compromise, which makes prompt diagnosis and treatment mandatory.

Cervical Vertebrae↗
PubMed1997

Lumbar facet joint infection associated with epidural and paraspinal abscess.

A case of lumbar facet joint infection associated with abscesses of the paraspinal muscles and the epidural space is presented. The infection did not respond to intravenous antibiotic therapy and resolved only after incision and drainage of the epidural space, involved facet joint, and paraspinal musculature. Magnetic resonance imaging, which showed a widened facet joint, epidural abscess, and paraspinal involvement, aided in diagnosis and preoperative planning. This condition is rare, and this report outlines some clinical characteristics of the infection and the usefulness of magnetic resonance imaging in visualizing the extent of the infection.

Abscess↗
PubMed2000

[Centrosomatic spinal tuberculosis: radiographic features in 10 cases].

We report a series of 10 cases of centrosomatic tuberculosis of the spine. The mean age of the patients was 36 years. Plain x-rays of the spine showed isolated defects in 3 cases, a defect with wedge fracture in 3 and a wedge fracture alone in 2. A sequestrum was found in 2 cases and bony condensation around the defect in 6. A CT scan performed in 3 cases showed, in addition to the bone lesions, a perilesional bony condensation in all cases. Soft tissue abscess formation was noted in 1 case and epidural involvement in the 2 others. MRI performed in 2 cases evidenced an alteration of the vertebral body signal with localized anterior epiduritis at the site of a small epidural abscess. CT scan and MRI contribute usefully to the radiographic diagnosis of centrosomatic tuberculosis, evidencing sequestra, bony condensation at the periphery of defects, and the presence of soft tissue abscesses and or epidural involvement. When these signs are absent, the differential diagnosis may be difficult with other causes of tumor formation, requiring vertebral biopsy.

Adult↗