Clivus and cervical spinal osteomyelitis with epidural abscess presenting with multiple cranial neuropathies

Azizi, Sepehr; Fayad, Pierre; Fulbright, Robert K.; Giroux, Monique; Waxman, Stephen G.

doi:10.1016/0303-8467(95)00036-j

Cited by 18 publications

(4 citation statements)

References 17 publications

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“…It is poorly understood whether these changes in preclival soft tissue are due to direct extension of an infection from the sphenoid sinus or the extension from the clivus itself. [ 33 136 137 ] Numerous granulomatous diseases and other inflammatory conditions, such as Wegener granulomatosis, tuberculosis, sarcoidosis, fibrous dysplasia, and Paget's disease of bone, may mimic the findings of central or atypical SBO on imaging studies and must also be ruled out before an accurate diagnosis is made. [ 33 64 ]…”

Section: Discussionmentioning

confidence: 99%

“…The clivus is usually involved in many pathogenic processes such as primary or metastatic neoplasm and vascular and infectious diseases. [ 137 141 ] Studies have shown that this condition generally occurs secondary to the direct spread of an infection from contiguous structures, involving the paranasal sinuses, or the adjacent bones of the base of skull, especially the posterior ethmoid and sphenoid bones. [ 30 142 143 ] There are little data to determine the origin of the infectious process.…”

Section: Discussionmentioning

confidence: 99%

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A comprehensive review of skull base osteomyelitis: Diagnostic and therapeutic challenges among various presentations

Khan¹,

Quadri²,

et al. 2018

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Skull base osteomyelitis (SBO) is a complex and fatal clinical entity that is often misdiagnosed for malignancy. SBO is commonly a direct complication of otogenic, sinogenic, odontogenic, and rhinogenic infections and can present as central, atypical, or pediatric clival SBO. This review describes the clinical profile, investigational approach, and management techniques for these variants. A comprehensive literature review was performed in PubMed, MEDLINE, Research Gate, EMBASE, Wiley Online Library, and various Neurosurgical and Neurology journals with the keywords including: SBO, central or atypical SBO, fungal osteomyelitis, malignant otitis externa, temporal bone osteomyelitis, and clival osteomyelitis. Each manuscript's reference list was reviewed for potentially relevant articles. The search yielded a total of 153 articles. It was found that with early and aggressive culture guided long-term intravenous broad-spectrum antibiotic therapy decreases post-infection complications. In cases of widespread soft tissue involvement, an early aggressive surgical removal of infectious sequestra with preferentially Hyperbaric Oxygen (HBO) therapy is associated with better prognosis of disease, less neurologic sequelae and mortality rate. Complete resolution of the SBO cases may take several months. Since early treatment can improve mortality rates, it is paramount that the reporting radiologists and treating clinicians are aware of the cardinal diagnostic signs to improve clinical outcomes of the disease. It will decrease delayed diagnosis and under treatment of the condition. However, due to rarity of the condition, complete prognostic factors have not fully been analyzed and discussed in the literature.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A comprehensive review of skull base osteomyelitis: Diagnostic and therapeutic challenges among various presentations

Khan¹,

Quadri²,

et al. 2018

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“…None of the patients who were treated nonoperatively had neurologic deficits at presentation, and the majority presented with neck pain and stiffness. 34 …”

Section: Management Of Uceamentioning

confidence: 99%

Upper Cervical Epidural Abscess in Clinical Practice: Diagnosis and Management

Al-Hourani

Al-Aref

Mesfin

2015

Global Spine Journal

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Study Design Narrative review. Objective Upper cervical epidural abscess (UCEA) is a rare surgical emergency. Despite increasing incidence, uncertainty remains as to how it should initially be managed. Risk factors for UCEA include immunocompromised hosts, diabetes mellitus, and intravenous drug use. Our objective is to provide a comprehensive overview of the literature including the history, clinical manifestations, diagnosis, and management of UCEA. Methods Using PubMed, studies published prior to 2015 were analyzed. We used the keywords “Upper cervical epidural abscess,” “C1 osteomyelitis,” “C2 osteomyelitis,” “C1 epidural abscess,” “C2 epidural abscess.” We excluded cases with tuberculosis. Results The review addresses epidemiology, etiology, imaging, microbiology, and diagnosis of this condition. We also address the nonoperative and operative management options and the relative indications for each as reviewed in the literature. Conclusion A high index of suspicion is required to diagnose this rare condition with magnetic resonance imaging being the imaging modality of choice. There has been a shift toward surgical management of this condition in recent times, with favorable outcomes.

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“…2,[34][35][36] Like typical SBIs, infections originating from the sinuses and nasal cavity are predominantly bacterial and often due to Pseudomonas and Staphylococcus species. 4,[37][38][39] Other routes of intracranial spread to consider include the round and oval windows, endolymphatic sac, cochlear aqueduct, and hematogenous seeding and sutures. 9…”

Section: Pathophysiologymentioning

confidence: 99%

Skull base infections, their complications, and management

et al. 2022

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Objective Our review aims to summarize the current literature on skull base infections (SBIs) and retrospectively analyze any such cases encountered at our institution. Design A literature search was conducted using online databases PubMed, MEDLINE, and ResearchGate with the terms “skull base osteomyelitis,” “temporal bone osteomyelitis,” “skull base infections,” “necrotizing otitis media,” and “SBO”. References from the resulting manuscripts were reviewed for relevant articles. A search of our electronic health records using the same key terms was also performed to identify patients with a tissue biopsy-confirmed diagnosis of skull base infections. Patients with an indeterminate diagnosis or inaccessible/poor imaging were excluded. Setting A level one trauma and major tertiary academic medical center. Participants All patients treated at the University of California Davis Health System with a confirmed diagnosis of skull base infections from January 2005 to November 2020. Main Outcome Measures Imaging results, symptoms, treatment, morbidity, and mortality. Results Our literature search yielded 59 articles ranging from 1982 to 2021. A retrospective search of our electronic health records identified two cases of skull base infections. Conclusion Skull base infections have no pathognomonic findings. A multimodal approach with computed tomography (CT), magnetic resonance imaging (MRI), and nuclear medicine is necessary to characterize the disease process in addition to a biopsy for definitive diagnosis. Other diagnoses can mimic SBI on imaging, such as nasopharyngeal carcinoma and inflammatory pseudotumor. Culture-guided antimicrobial treatment and surgery are mainstay therapies. Other adjuvant strategies currently lack the robust evidence necessary to characterize their risks and benefits.

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Clivus and cervical spinal osteomyelitis with epidural abscess presenting with multiple cranial neuropathies

Cited by 18 publications

References 17 publications

A comprehensive review of skull base osteomyelitis: Diagnostic and therapeutic challenges among various presentations

A comprehensive review of skull base osteomyelitis: Diagnostic and therapeutic challenges among various presentations

Upper Cervical Epidural Abscess in Clinical Practice: Diagnosis and Management

Skull base infections, their complications, and management

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