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PubMed1996

Proximal paraparesis following spinal anesthesia.

A 70-year-old man with prostatic cancer extending to the urinary bladder underwent transurethral resection of the bladder neck under spinal anesthesia and developed weakness of the proximal lower limbs a few hours after the procedure. The weakness persisted for several months. Because there were no local surgical complications (hematoma, infectious epiduritis, abscess) or bone metastases responsible for nerve root or spinal cord compression, a causal relation between the neurologic deficit and the spinal anesthesia was considered likely. Neurologic deficits are uncommon after spinal anesthesia and can be produced by complications of the surgical procedure (direct nerve injury, hematoma, abscess), arachnoiditis, neurotoxicity of disinfectants or of preservatives added to solutions of anesthetic drugs, or spinal cord ischemia. Precipitating factors for spinal cord ischemia include faulty patient position during the procedure, intraoperative arterial hypotension and injection of vasoconstricting agents.

Aged↗
PubMed1997

Failure to obtain durable results with collagen implantation in children with urinary incontinence.

PURPOSE: We studied the efficacy and durability of injection of glutaraldehyde cross-linked bovine collagen for treating urinary incontinence in children. MATERIALS AND METHODS: From April 1994 to July 1995, 12 boys and 8 girls 4 to 18 years old (mean age 9.5) underwent endoscopically directed collagen injections into the bladder neck. Followup ranged from 9 to 23 months (mean 15.2). The etiology of incontinence included myelodysplasia in 12 patients, exstrophy/epispadias in 4, and epidural abscess, sacral agenesis, imperforate anus and posterior urethral valves in 1 each. RESULTS: Collagen was injected once in 9 patients, twice in 10 and 3 times in 1. Injected volume ranged from 3 to 18 cc (mean 7.3). Followup urodynamic studies were available for 10 patients. Leak point pressure increased from 28.7 to 34.9 cm. water. One patient (5%) was dry, 5 (25%) had improvement, 10 (50%) had transient improvement for 2 to 90 days (mean 52) and 4 (20%) remained incontinent. Five children underwent bladder neck sling procedures. In 1 patient transient sciatic nerve irritation developed due to gluteal hematoma. CONCLUSIONS: The previously reported high success rate of collagen injection for urinary incontinence in children is unsupported by this study. Improvement in continence was temporary or inadequate in the majority of patients. Collagen therapy may only delay the need for surgery for managing organic urinary incontinence in children.

Adolescent↗
PubMedDate not supplied

[How to manage intracranial empyemas in the absence of computerized tomography?].

BACKGROUND: Intracranial, and especially subdural, empyemas are a medical emergency usually requiring surgical intervention. We suggest herein a protocol for their management in areas where CT is not yet available. MATERIALS AND METHODS: 16 patients with supratentorial empyemas (6 epidural abscesses, 6 subdural empyemas and 4 with both) diagnosed by surgical intervention in our department between 1986 and 1995 were studied. The etiological features were frontal sinusitis (7 cases), mastoid infection (1), trauma (5), previous operations (2) and unknown (1). Three patients were in a normal state of consciousness, 8 were drowsy and 5 were in a coma. Antibiotic treatment was empirical in 6 patients and specific in 10 patients. Surgical treatment was by multiple burr holes in 9 patients, small craniotomies in 3 patients, major craniotomies in 3 patients and by exploration of a previous craniotomy in 1 patient. A catheter was used for drainage in 12 patients. RESULTS: Average follow-up was 2.7 years. Two patients died, 3 had seizures and 11 were able to lead a normal life. CONCLUSION: We recommend a regime of 2 or 3 antibiotics as an initial treatment. A number of factors including ecological environment, availability of drugs and financial circumstances of each patient should be considered when determining the treatment to be used. Surgical techniques vary according to the surgeon's experience. In our medical centre, drainage via burr-holes is the initial method of treatment for supratentorial empyemas.

Adolescent↗
PubMed1998

Percutaneous transpedicular discectomy and drainage in pyogenic spondylodiscitis.

Spondylodiscitis normally heals itself, but it can cause bone destruction leading to deformity and often pain. Debridement of these infections by percutaneous transpedicular discectomy with access from adjacent caudal pedicles can accelerate natural healing and prevent progression to bone destruction and deformity. We outline this technique and discuss a series of 28 patients treated using a percutaneous transpedicular approach to obtain culture and histopathology specimens, permit drainage and antibiotic irrigation, and provide a channel for granulation tissue to invade the infected space. This procedure is safe and effective, but it is contraindicated for epidural abscess or granulation tissue-induced neurocompression and it is ineffective against extensive bone destruction.

Adolescent↗
PubMed1998

Paraspinal abscess associated with epidural in labour.

A 24-year-old presented in labour requesting an epidural. She had been diagnosed as having "pelvic arthropathy" at 37 weeks. After an uneventful epidural and instrumental delivery, she discharged herself home. She re-presented 19 days later with left hip pain and abnormal neurological signs in the lower limbs. On MRI, there was a large paraspinal abscess with an epidural granulation mass compressing her spinal cord. She had an urgent surgical decompression. In hindsight, it is likely that the paraspinal mass was present at the time of epidural insertion. The discussion highlights that complications are sometimes not what they seem.

Abscess↗
PubMed2003

[28-Year-Old Patient with Elevated Serum IgE Levels and Multiple Refractory Epidural and Paravertebral Abscesses. Clinical manifestation of a Job's Syndrome?].

BACKGROUND: The hyper-IgE syndrome is a rare primary immunodeficiency characterized by recurrent staphylococcal infections and high levels of serum IgE. CASE REPORT: The case of a 28-year-old man with epidural and paravertebral abscesses and a markedly elevated serum IgE level of 2,609 U/ml is reported. There was no allergic diathesis, nor had the patient a history of other diseases, which might explain the high serum IgE level. In a blood culture, Staphylococcus aureus was detected. Since early childhood, the patient has suffered from recurrent skin infections. CONCLUSION: The presented study case discusses the diagnosis of a Job's syndrome in this patient and reviews previously published cases. It also summarizes the current knowledge about pathogenesis and diagnostic criteria of this rare syndrome.

Adult↗
PubMed1977

Computed tomography (CT) in the diagnosis of intracranial abscesses. Brain abscess, subdural empyema, and epidural empyema.

Nine cases of brain abscess, five of subdural empyema, and one of epidural empyema with associated subdural empyema were identified using computed tomography (CT). Smal and multiple abscesses as well as unilateral, bilateral, and parafalcine empyemas were detected. These lesions were demonstrated rapidly and accurately, even in areas that are demonstrated poorly by other diagnostic techniques. No false-negative studies were found in cases of brain abscess or subdural empyema. However, since the appearance of brain abscesses of CT scans is similar to that of neoplastic and vascular lesions, false-positive reports of brain abscess were encountered.

Brain Abscess↗
PubMed2002

Low back pain at presentation in a newly diagnosed diabetic.

Insulin dependent diabetes mellitus predisposes to a range of different and unusual infections, including epidural and psoas abscesses. However, they occur mainly in adults with longstanding diabetes. We report the case of a 12 year old boy who presented with diabetic ketoacidosis and low back pain, and was subsequently diagnosed with both a left psoas abscess and an extensive thoracolumbar spinal epidural abscess measuring 20 cm in length. This case report highlights the need to maintain a high index of suspicion for epidural abscesses in children presenting with fever and localised back pain. Early diagnosis with appropriate imaging and aggressive management can prevent development of permanent neurological damage as was the case in our patient.

Child↗
PubMed2001

[Septic arthritis of a lumbar facet joint associated with epidural and paravertebral soft tissue abscess].

Septic arthritis of the lumbar facet joint is rare, probably underdiagnosed, often associated with complications such as epidural abscess and paraspinal muscles abscess. Diagnosis is based on imaging evaluation. Plain radiographs of the lumbar spine are not helpful because often nomal. Bone scintigraphy is very sensitive but non-specific. CT scan can confirm the diagnosis and guide the needle biopsy. MRI is the preferred imaging modality for diagnosis. MRI shows early bone and joint involvement and it is helpful in detecting epidural and paravertebral soft tissue lesions.

Aged↗
PubMed2006

Textiloma: a case of foreign body mimicking a spinal mass.

Items such as cotton or gauze pads can be mistakenly left behind during operations. Such foreign materials (called textilomas or gossypibomas) cause foreign body reaction in the surrounding tissue. The complications caused by these foreign bodies are well known, but cases are rarely published because of medico-legal implications. Some textilomas cause infection or abscess formation in the early stage, whereas others remain clinically silent for many years. Here, we describe a case of textiloma in which the patient presented with low-back pain 4 years after lumbar discectomy. Imaging revealed an abscess-like mass in the lumbar epidural space.

Chronic Disease↗