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PubMedDate not supplied

Early diagnosis of a spinal epidural abscess.

Epidural abscess is a neurologic emergency. Diagnosis may be difficult and costly to patients and health care providers in terms of time and money expended. We present a case of epidural abscess diagnosed in a cancer patient with an implanted epidural catheter. Diagnostic studies were performed that documented the presence of a spinal epidural abscess. Routine aspiration of an implanted epidural catheter facilitated the early diagnosis of epidural abscess in our patient prior to the performance of these studies.

Abscess↗
PubMed2001

Long-term outcome after neurosurgically treated spinal epidural abscess following epidural analgesia.

BACKGROUND: A recent investigation demonstrated a high incidence of epidural abscess secondary to epidural catheterization and a 50% frequency of neurologic deficits. We studied short- and long-term neurologic outcome in patients operated for spinal epidural abscess after epidural analgesia. METHODS: Nineteen patients who had undergone neurosurgical decompression and drainage of a spinal epidural abscess during a 5-year period at three neurosurgical departments in East Denmark were identified by manual review of operating lists. RESULTS: Median epidural catheterization time was 8 days (range 3-44). Preoperatively 12 patients suffered from inferior paraparesis, one had irradiating pain from the back, and 6 patients had no neurologic deficits. Postoperatively 2 patients had recovered, but 3 other patients had deteriorated; therefore, 13 patients were discharged with paresis/plegia. Seven patients died during a median follow-up time for all patients of 41.6 months. One patient recovered completely, and one suffered from minor deficits. The remaining patients suffered from paraparesis/plegia or bladder/bowel dysfunction. CONCLUSION: Overall recovery rate for patients with paresis/plegia after epidural abscess was 20%. No patients with paresis/plegia following a thoracic abscess recovered in contrast to a 50% recovery rate for patients with lumbar epidural abscess. The majority of long-term survivors had severe neurologic deficits. Abscess formation contributed to one death.

Abscess↗
PubMed1997

[A case of acute cervical epidural abscess].

Epidural abscess is very uncommon in the cervical region, and it is difficult to diagnose because of the diversity of its clinical course. The resulting neurological deficits remain unacceptably severe because of delays in diagnosis and treatment. We present a rare case of acute cervical epidural abscess. A 57-year-old man was admitted to our hospital because of esophageal carcinoma. During an overnight stay outside the hospital, he experienced sudden lumbago while removing snow at his home. The next day he developed back pain and high fever. He was drowsy but complained of neck pain. Lumbar puncture was dry. Two hours after the procedure, he developed respiratory arrest and became comatose. Consciousness and motor function recovered in response to artificial ventilation, but tetraplegia developed three days later. Cervical enhanced-CT suggested an epidural abscess. Emergency decompression laminectomy and drainage of the abscess combined with systemic antibiotics was performed. Postoperatively, the patient was afebrile, and his respiration and motor function gradually recovered. The histopathological diagnosis was abscess, but its origin was undetermined.

Abscess↗
PubMed2004

Cervical epidural abscess after epidural steroid injection.

STUDY DESIGN: This is a case report of a cervical epidural abscess presenting with neurologic deficits after cervical epidural steroid injection. OBJECTIVE: To describe the presentation, diagnosis, treatment, and outcome of a rare complication of cervical epidural steroid injection. SUMMARY OF BACKGROUND DATA: Cervical epidural steroid injections are a commonly used modality in the treatment of cervical spine disease. Serious complications from the procedure are rare. There is only one previously reported case of cervical epidural abscess after cervical epidural injection in the literature. MATERIALS AND METHODS: A case of cervical epidural abscess after epidural steroid injection is presented and the relevant literature is reviewed. RESULTS: The patient had partial recovery of neurologic function within the first 24 hours after decompressive laminectomy, irrigation, and debridement. There were no perioperative complications. Intraoperative cultures permitted positive identification of the infecting organism and appropriate antibiotic selection. At 7-month follow-up, there was no recurrence of infection and the patient had recovered baseline neurologic function and neck pain status. CONCLUSIONS: Cervical epidural abscess is a rare but potentially devastating complication after epidural steroid injection. Neurologic compromise may occur. Timely diagnosis and appropriate treatment may result in good clinical outcomes.

Cervical Vertebrae↗
PubMed1995

MR imaging appearances of cervical epidural abscess.

Epidural abscess of the cervical spine is an uncommon disorder. The presentation is often non-specific and the diagnosis unsuspected. Magnetic resonance (MR) imaging is now considered the imaging investigation of choice. We report six patients with cervical epidural abscess diagnosed on MR imaging. The MR imaging showed the abscess to have a variable appearance and enhancement characteristics. Follow-up MR examinations confirmed resolution of the abscess and, in five cases, allowed conservative management.

Abscess↗
PubMed1998

Epidural abscess complicating epidural anesthesia and analgesia. An analysis of the literature.

BACKGROUND: Epidural abscess is a serious complication of epidural block. Because of its low incidence, the risk factors and the symptoms and cause of epidural abscess related to epidural anesthesia and analgesia are not well known by anesthesiologists. METHODS: A computer-assisted search of the literature on epidural catheter-related abscess was performed to describe the clinical course and bacteriology of this complication, to determine possible risk factors, and to assess the index of suspicion among physicians. RESULTS: Forty-two patients with a catheter-related epidural abscess were identified. Only in 15 patients was the correct diagnosis considered initially. The time from insertion of the epidural catheter to symptoms varied between 1 and 60 d. Initial symptoms included back pain, fever, and leukocytosis. The time from symptoms to treatment was a few hours to 108 d. Interval from first symptoms to treatment was significantly longer in patients with persistent neurologic deficits compared with patients who completely recovered. Staphylococcus aureus was the most common etiologic agent. Outcome was reported in 39 patients, but only 19 made a full recovery. CONCLUSION: The index of suspicion among anesthesiologists, other physicians and nurses taking care of patients with epidural catheters must be increased for this complication; this should shorten the interval from symptoms to treatment and lower the incidence of neurological sequelae.

Abscess↗
PubMed1997

Epidural abscess following epidural steroid and local anaesthetic injection.

Epidural abscess is a well-recognised but rare complication of epidural catheter placement. We have found only five previous reports of epidural abscess from noncatheter-related administration of steroids and/or local anaesthetic. We describe a further case which led to critical illness and emphasise the association between diabetes mellitus and epidural infection.

Abscess↗
PubMed2000

Epidural abscess after epidural catheter for pain release during pancreatitis.

BACKGROUND: Despite knowledge about compromised host defence in the course of diabetes mellitus and pancreatitis, epidural analgesia (EA) is recommended for pain management during pancreatitis. CASE REPORT: We present the case of a diabetic patient with pancreatitis who developed an epidural abscess after 3 days with an epidural catheter. Natural killer and T-helper cell counts were distinctively reduced in the absence of HIV serology. Furthermore, a synthesis failure of the liver was observed and evidenced by low cholinesterase, low whole protein fraction and low antithrombin III in the peripheral blood. CONCLUSION: We suggest that the combination of pancreatitis, diabetes and compromised immunity might be a contraindication to epidural analgesia.

Abscess↗
PubMed2004

[Vertebral osteomyelitis and epidural abscess after epidural anesthesia for a cesarean section].

A 40-year-old woman underwent cesarean section under epidural anesthesia. The anesthetic procedure was carried out in strict aseptic conditions, the catheter was withdrawn 24 hours after surgery, and the patient was discharged 5 days after surgery. She was readmitted with fever, backache, and pain in the lower limbs, with signs of radiculitis but no indication of inflammation or pain at the site of puncture. Magnetic resonance imaging revealed vertebral osteomyelitis at the fifth lumbar and first sacral vertebrae and an epidural abscess with compression of the nerve root. Treatment consisted of 2 g of ceftriaxone daily for 6 weeks, rest, and measures to assure local immobilization. Symptoms gradually improved and no surgical drainage measures were needed. The cause of osteomyelitis was never ascertained. Vertebral osteomyelitis is an unusual event after epidural anesthesia and there have been few opportunities to demonstrate a relationship. Such infections appear spontaneously in immunodepressed patients who undergo diagnostic procedures and treatments that lead to bacteremias with secondary colonization of spinal structures. The topography and characteristics of the infectious lesion, the patient's susceptibility, and the anesthetic procedure and pathogenic agent may help clarify the cause of the osteomyelitis.

Adult↗
PubMed2003

Poor outcome following epidural abscess complicating epidural analgesia for labour.

Abscess is a rare complication of epidural analgesia that may occur post-partum. A case is described where a lumbar epidural abscess initially presented with back and leg pain 7 days after seemingly uneventful block for labour and forceps delivery of twins. Definitive diagnosis of abscess was delayed until 5 days later when neurological sequelae became apparent. Despite surgical evacuation, recovery was delayed and incomplete. The importance of prompt diagnosis and the involvement of anaesthetic personnel are emphasised.

Adult↗
PubMed1998

Sinusitis-associated epidural abscess presenting as posterior scalp abscess--a case report.

Complications of paranasal sinusitis constitute true surgical and medical emergencies. These complications appear to be more prevalent and seem to present in a more fulminant manner in the pediatric age group. The most common complication of paranasal sinusitis is orbital cellulitis followed collectively by all the intracranial complications. These include meningitis, subdural empyema, intracerebral abscess, epidural abscess and rarely cavernous or superior sagittal sinus thrombosis. We report the case of a 7-year old boy who presented with posterior scalp cellulitis and abscess as a complication of minimally symptomatic paranasal sinusitis. A combined neurosurgical and otolaryngologic approach was required to treat a unilateral ethmoid and frontal sinusitis associated with an epidural abscess abutting the length of the superior sagittal sinus and a posterior subgaleal abscess. The pertinent anatomy allowing for the development of this disease process is discussed. The danger of neurologic sequellae resulting from thrombosis of the superior sagittal sinus is emphasized. Aggressive treatment utilizing a multi-disciplinary surgical approach as well as broad spectrum antibiotics is paramount to obtain the best chance for a full recovery.

Abscess↗