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Results for “Epidural Abscess”

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PubMed2004

[Clinical suspicion of vertebral osteomielitis: back pain in patients with hemodyalisis by catheter related infection].

The overall incidence of vertebral osteomyelitis is increasing due to, the increasing rates of bacteraemia due to intravascular devices. We report a patient with end-stage renal failure under hemodialysis by internal jugular catheters who started with back pain after several episodes of Staphylococcus aureus bacteraemia, and whose magnetic resonance imaging was showed signs suggestive of spondylodiscitis. Other 4 similar cases from our service have been analysed, thereby we can conclude the most effective treatment of vertebral osteomyelitis and/or epidural abscess is premature diagnosis of these pathologies. Magnetic resonance imaging is the most sensitive radiologic technique whom we have. Treatment of vertebral osteomyelitis must be preceded by a correct bacteriological diagnosis. Surgery plays a central role in the successful treatment and should be performed as soon as neurological problems are apparent.

Anti-Bacterial Agents↗

PubMed2001

Septic arthritis of a lumbar facet joint due to pyonex.

We present a case of septic arthritis of a lumbar facet joint with an associated epidural abscess. A 13-year-old boy was hospitalized with acute severe back pain and fever after pyonex was done. The infection was precisely localized with magnetic resonance imaging, bone and gallium scintigraphy. He responded to antibiotic therapy. We suppose that the infection was caused by pyonex because the blood cultures were negative, and the patient had an abrupt onset of severe pain and fever 24 h after the acupuncture.

Acupuncture Therapy↗

PubMedDate not supplied

Spinal infections.

Spinal infections can occur in a variety of clinical situations. Their presentation ranges from the infant with diskitis who is unwilling to crawl or walk to the adult who develops an infection after a spinal procedure. The most common types of spinal infections are hematogenous bacterial or fungal infections, pediatric diskitis, epidural abscess, and postoperative infections. Prompt and accurate diagnosis of spinal infections, the cornerstone of treatment, requires a high index of suspicion in at-risk patients and the appropriate evaluation to identify the organism and determine the extent of infection. Neurologic function and spinal stability also should be carefully evaluated. The goals of therapy should include eradicating the infection, relieving pain, preserving or restoring neurologic function, improving nutrition, and maintaining spinal stability.

Adult↗

PubMed2003

[Sequelae of diabetes mellitus in the vertebral column and spinal cord].

Diffuse idiopathic skeletal hyperostosis (DISH) is a chronic disease of the spine characterized by a significant association with metabolic alterations such as diabetes mellitus. Diabetes decreases the immunocompetence and increases the susceptibility to infections such as spondylitis, spondylodiscitis, and epidural abscess with spinal cord lesions in a high percentage of the cases. Microangiopathic changes of the intrinsic vasculature of the spinal cord are rare and mild. In a retrospective study of 784 acute spinal cord lesions, suspected diabetes could be found in only 13 patients. Neurophysiological and animal experiments as well as pathological studies have provided proof for the presence of diabetic myelopathy. Diabetic neuroarthropathy of the spine is rare, but important in the differential diagnosis of spinal disorders.

Angiography↗

PubMed2006

Acute paraplegia following chiropractic therapy.

We report a 44-year-old man suffering complete paraplegia due to paraspinal and epidural abscess, following chiropractic therapy for severe back pain and whose diagnosis was delayed. He received an immediate laminectomy from T3 through T6 to decompress the full extent of the abscess and appropriate antibiotic therapy for 4 weeks postoperatively for the identified microorganism (Staphylococcus aureus). After 3 months of rehabilitation, he had recovered bladder function with moderate left lower extremity paresis. We emphasise the importance of urgent spinal gadolinium-enhanced MRI in those patients with localised back pain and raised inflammatory markers (including erythrocyte sedimentation rate). Furthermore, it is necessary to be aware of the risk of acute paraplegia after forceful massage to the back.

Acute Disease↗

PubMed2002

Nocardia farcinica spinal osteomyelitis.

STUDY DESIGN: A case of disseminated Nocardia farcinica infection with spine involvement is reported. OBJECTIVE: To describe the first case of Nocardia farcinica spinal osteomyelitis, and to propose spine instrumentation with debridement and multiple antibiotics for treatment of nocardia spinal osteomyelitis. SUMMARY OF BACKGROUND DATA: Only 11 cases involving Nocardia asteroides spinal osteomyelitis have been reported over the past 40 years. These case reports describe various presentations and treatments of nocardia spinal osteomyelitis. METHODS: A 54-year-old nonambulant, paraparetic man was admitted to the authors' hospital with acutely increased low back pain, fever, and signs of dementia. A disseminated Nocardia farcinica infection including spinal osteomyelitis at T11, T12, L1, L2, and L4; epidural abscess T10-L4, L5-S1 discitis, empyemas, cerebral abscess, and bilateral psoas abscess was noted. RESULTS: Antibiotic therapy, multiple debridements, and posterior instrumentation were performed to palliate the Nocardia farcinica infection. At a recent 3-year follow-up assessment, the patient was independent and ambulant. He had been off antibiotics for 5 months. CONCLUSIONS: Previous case reports of nocardia spinal osteomyelitis describe treatment with antibiotics, debridements, and arthrodesis with autologous bone graft. Prolonged recumbency ensued. In the reported case, a combination of antibiotics, debridements, arthrodesis, and posterior instrumentation for immediate stabilization of the spine resulted in a favorable outcome at 3 years.

Epidural Abscess↗

PubMed1999

Streptococcus pneumoniae spinal infection in Nottingham, United Kingdom: not a rare event.

Pneumonia and meningitis are the most frequent manifestations of Streptococcus pneumoniae infection. Spinal infection is considered to be a rarity. Between 1985 and 1997, 8 patients with spinal infection (vertebral osteomyelitis, 3; spinal epidural abscess, 1; both, 4) due to S. pneumoniae were seen at University Hospital (Nottingham, U.K.). Predisposing factors for pneumococcal infection were documented for five patients and included diabetes mellitus, alcoholism, and corticosteroid therapy. One patient presented with concomitant meningitis and endocarditis. Clinical features of note were prolonged symptoms and a lack of febrile response. S. pneumoniae was isolated from the blood of five patients. Magnetic resonance imaging was used to localize the spinal infection in five patients. Two cases were managed medically. Three patients died after a protracted illness. A literature search revealed 20 other cases of spinal infections due to S. pneumoniae. The salient features of the cases are summarized.

Aged↗

PubMed2000

Complications of acute sinusitis in children.

Acute sinusitis is often a mild, self-limiting disease. However, in some cases, especially among children, sinusitis may become a severe, even life-threatening, disease. To examine the nature of complications of acute sinusitis, we studied the cases of children treated at the Helsinki University ENT Hospital, because of a complication caused by acute sinusitis from January 1997 to September 1998. There were 12 children (4 girls, 8 boys), whose ages ranged from 16 months to 16 years. One child had an epidural abscess, one got meningitis and cavernous sinus thrombosis, five had orbital cellulitis, one of whom lost her vision permanently in one eye, and five had preseptal cellulitis. All the children were treated with intravenous antibiotics and all, except the youngest, were treated with a direct sinus puncture. An operation (intranasal antrostomy, orbital drainage, functional endoscopic sinus surgery or adenoidectomy) was performed on six patients. In the majority of children, acute sinusitis is a mild self-limiting disease. However, severe complications still exist. When a complication of sinusitis is suspected, it is of utmost importance that the child be sent immediately to a hospital for proper diagnosis and treatment.

Acute Disease↗

PubMed2005

Adjacent level discitis after anterior cervical discectomy and fusion (ACDF): a case report.

This report describes a case of spondylodiscitis occurring adjacent to levels at which anterior cervical discectomy and fusion was performed. The objective is to describe a rare cause of spondylodiscitis and discuss its successful management. Post-operative discitis involving the same level is a known occurrence. We report an interesting case of spondylodiscitis occurring at the adjacent level of fusion, and to our knowledge this is the first such case reported in literature. A two-level decompression and fusion was performed at C5-6 and C6-7 levels with PEEK cages and anterior cervical plating in a middle-aged gentleman for persistent axial neck pain and left-sided radiculopathy involving C6 and C7 distribution. After 6 weeks, the patient presented to us with complaints of mild paresthesia in the abdomen and extremities. Radiological investigations including plain radiographs and MRI revealed a surprising finding of discitis at C4-5 level with an associated epidural abscess. In view of the patient's myelopathic symptoms, surgical debridement and decompression of the spinal cord was performed. The plate and screws were removed, the cages were left intact, and the C4-5 disc level was reconstructed with tricortical iliac crest autograft. No further instrumentation was performed. The biopsy specimen from the disc at C4-5 level grew Serratia marcescens. It was contemplated that C4-5 discitis was initiated by inoculation of bacteria at the superior endplate of C5 by contaminated vertebral pins/drill-bit or screws. Adjacent level discitis is a rare but potentially serious complication of anterior cervical fusion. A high index of suspicion of infection is necessary if the patient complains of new symptoms after anterior cervical fusion. Thorough assessment and aggressive treatment is necessary for successful management.

Bone Plates↗

PubMed2006

Two-stage reconstructive surgery of a patient with head trauma resulting in extensive cranial bone and dura mater loss caused by postoperative infection: usefulness of a pericranial flap for dura mater reconstruction.

After external decompression for a case of head trauma, epidural abscess formation resulted in extensive cranial bone and dura mater loss, for which two-stage reconstructive surgery was conducted. In the first operation, after thorough debridement of the infected wound, the dura mater was reconstructed using a bipedicle pericranial flap with posterior and anterior pedicles. After the infection had completely subsided, the second operation was performed, reconstructing the cranium with grafted outer-table calvarial bone and cutting bone to reposition an old zygomatic fracture. At this point, the pericranial flap used for dura mater reconstruction in the first operation became a satisfactory graft bed for the grafted bone. The postoperative course was satisfactory, and there was no cranial bone absorption after roughly 2 year, and a favorable shape has been maintained for an extremely satisfying result.

Adult↗

PubMed2003

Natural history of sigmoid sinus thrombosis.

To demonstrate the evolution of sigmoid sinus thrombosis, we performed a prospective observational study on a 6-year-old girl who presented with mastoiditis, epidural abscess, and occipital osteomyelitis from multiple drug-resistant Streptococcus pneumoniae. She underwent mastoidectomy and partial occipital craniectomy. This procedure produced a window in the occipital bone that allowed serial ultrasonography of the sigmoid sinus during medical treatment. Computed tomography was performed, followed by weekly Doppler ultrasonography used to monitor resolution of sigmoid sinus thrombosis. The natural history of a treated episode of sigmoid sinus thrombosis was illustrated. Venous occlusion resolved over a 4- to 6-week period without surgical drainage or venous anticoagulants. Collateral flow, reversal of normal venous flow, and ultimate return to normal venous transport characterized the period of resolution. We conclude that an occluded sigmoid sinus from mastoiditis can naturally recanalize. Aberrant venous flow can be demonstrated during the period of resolution. This case supports a conservative approach to management of the occluded sinus and suggests that 4 to 6 weeks of antibiotic therapy after removal of perisinus infection is sufficient for cure.

Anti-Bacterial Agents↗

PubMed2004

Nonspecific pyogenic spondylodiscitis: clinical manifestations, surgical treatment, and outcome in 24 patients.

OBJECT: Pyogenic vertebral osteomyelitis is of special interest to neurosurgeons because it often results in acute neurological deterioration and requires a combination of adequate surgical and conservative treatment. The aim of the current study was to evaluate the strategy of a primary surgical approach to this disease. METHODS: A group of 24 patients with the clinical and radiological signs of acute pyogenic spondylodiscitis was prospectively followed from 1998 to 2004. Of these, 20 had underlying diseases such as diabetes mellitus, chronic alcoholism, and liver cirrhosis. The main causative organism was Staphylococcus aureus. Most infections were localized in the thoracic or lumbar spine (10 cases each); 15 infections were associated with epidural abscesses. Because of a delay in diagnosis, 13 patients presented with neurological deficits on admission. Patients with a complete or rapidly progressing neurological deficit underwent immediate surgery. In patients with minor or no deficits or in a stable neurological condition, surgery was delayed for 3 to 5 days. This group was treated with immobilization and intravenous antibiotic drugs before surgery. Surgical procedures included ventral, dorsal, and combined approaches in one- or two-stage operations. Antibiotic treatment included the use of broad-spectrum antibiotic drugs delivered intravenously for at least 10 days, followed by orally administered antibiotics for 3 months. Twenty patients were independent on follow-up review, 15 with no or minor handicaps. Severe septicemia and multiorgan failure developed in two patients, and these two died of their disease. Major complications were mainly due to long-term antibiotic therapy. CONCLUSIONS: Surgical treatment is the modality of choice in patients with acute spinal osteomyelitis. It is especially indicated in patients with progressive or severe neurological deficits and spinal deformity. In experienced hands, surgery is safe and offers the advantages of spinal cord decompression, immediate mobilization, and correction of spinal deformity. The decision whether an anterior or posterior approach should be used must be made on an individual basis.

Adult↗

PubMed1996

Major neurological sequelae of lumbar epidural anesthesia. Report of three cases.

We here report the major permanent neurological complications that developed in three patients after epidural anesthesia. MR clearly showed that paraplegia, which arose one and nine days after anesthesia, was due to epi-subdural haematoma in the first case and epidural abscess in the second. The sudden left lower limb palsy in the third patient was caused by a paracentral ischemic lesion all along the conus-epiconus following a probable trauma of the cord during the insertion of the needle. Despite the fact that this was reported to have been performed at L1-L2, an erroneous introduction into the upper interspace must be postulated since the spinal cord of this patient terminated at mid-L1. Our report is useful insofar as it may remind anesthesiologists and neurologists to pay attention to the unusual complications of spinal anesthesia that may require urgent intervention.

Abscess↗

PubMed2002

Contrast-enhanced MR imaging with fat suppression in adult-onset septic spondylodiscitis.

Spinal infections typically involve vertebrae as well as discs, and for this reason they are called septic spondylodiscitis. Magnetic resonance imaging is the most sensitive imaging method for the evaluation of this group of spinal diseases. The use of contrast-enhanced T1-weighted sequences with fat suppression, if correctly applied, may increase information provided by MRI. Firstly, this technique allows the primary vertebral focus, which often precedes disc involvement, to be identified at a very early stage. When the disease spreads, T1-weighted fat-suppressed gadolinium dimeglumine (Gd-DTPA) enhanced images provide macroscopic details of the primary vertebral focus, disc involvement patterns, and pathways of infection diffusion. All this information, when correlated with laboratory tests, may be useful in identifying the infectious agents (tuberculous vs piogenic forms), thus enabling a suitable therapy to be started. This technique is also useful in the assessment of the real extension of the disease, providing a clear depiction of paravertebral space involvement and of psoas muscle abscesses. Dangerous complications, such as meningitis, myelitis, and epidural abscesses, may be more promptly diagnosed and fully evaluated with fat-suppressed post-contrast T1-weighted images. Finally, this imaging technique may help to differentiate infectious processes from degenerative disorders, extradural neoplastic processes, and rheumatic diseases.

Adipose Tissue↗

PubMed1992

Ataxia in epidural spinal cord compression.

Nine patients presented with ataxia as the primary manifestation of epidural spinal cord compression. Eight had known cancer, the ninth an epidural abscess. Lower-extremity dysmetria, gait ataxia, or both, were the only neurologic signs in five patients. An incorrect initial diagnosis led to delay in treatment and subsequent neurologic deterioration in six patients. Failure to recognize isolated, painless ataxia as the initial manifestation of spinal cord compression and appropriately treat the disorder can result in irreversible spinal cord deterioration.

Abscess↗

PubMedDate not supplied

Emergency magnetic resonance examination of patients with spinal cord symptoms.

Eighteen consecutive patients with spinal cord symptoms of sudden or relatively sudden onset were examined with magnetic resonance imaging (MRI). The examinations were performed on a 0.3 tesla permanent/resistive imaging system using solenoidal surface coils. MRI revealed epidural tumour in five patients, intramedullary tumour in one, epidural abscess in one, myelitis in two, spontaneous intraspinal epidural haematoma in two, disc herniation in two, traumatic lesions in four and no abnormality in one patient. MRI was found to be capable of non-invasively and painlessly detecting and exactly defining the extent of intraspinal and paraspinal lesions. In some cases the nature of the lesion could be inferred from specific signal characteristics, which is a unique property of MRI. The results strongly suggest that MRI is superior to myelography and other imaging methods and should be regarded as the examination of choice in the emergency examination of patients with spinal cord symptoms.

Adult↗

PubMed1997

[Peridural abscess complicating spinal anesthesia in a diabetic patient].

Infectious complications of spinal or epidural anaesthesia are rare, particularly after spinal anaesthesia. Most of them consist of a meningitis. We report a case of epidural abscess due to Staphylococcus aureus following spinal anaesthesia in a 62-year-old diabetic patient, diagnosed 45 days after the puncture with bacterial samples and magnetic resonance imaging. The pejorative neurological outcome required a laminectomy in spite of an efficient anti-staphylococcal treatment.

4-Quinolones↗

PubMed2003

Intracranial infection associated with preseptal and orbital cellulitis in the pediatric patient.

PURPOSE: To identify risk factors in children admitted with preseptal or orbital cellulitis with associated intracranial infection. METHODS: A retrospective chart review identified 10 patients (< or = 18 years) with a diagnosis of preseptal or orbital cellulitis and a concurrent or subsequent diagnosis of intracranial infection. RESULTS: Diagnoses confirmed by imaging included sinusitis (n = 10), preseptal cellulitis (n = 4), orbital cellulitis (n = 6), orbital subperiosteal abscess (n = 5), Pott's puffy tumor (n = 4), epidural empyema (n = 2), epidural abscess (n = 6), and brain abscess (n = 2). The timing of diagnosis of intracranial infection ranged from hospital day 1 to 21. All but 1 patient had positive microbial cultures. Seven of 10 patients had positive microbial cultures from two or more sites, 70% of which were polymicrobial; Streptococcus species and Staphylococcus species were the most commonly isolated bacterial pathogens. All patients required both medical and surgical therapy; all 10 patients underwent sinus surgery; 8 patients required neurosurgical craniotomy; and 5 patients underwent orbital surgery. There were no deaths. CONCLUSION: Intracranial involvement should be suspected in any patient age > or = 7 years with preseptal or orbital cellulitis associated with orbital subperiosteal abscess, Pott's puffy tumor, concurrent sinusitis, complaints of headache, and continuing fever despite intravenous antibiotics. Given the high incidence of polymicrobial infection found on cultures in this series, broad-spectrum antibiotics are strongly indicated. When imaging the orbits and sinuses in such patients, we recommend including the brain to rule out intracranial involvement.

Adolescent↗