Epidural infection: Is it really an abscess?

Abstract

Background:We reviewed the literature regarding the pathogenesis, clinical presentation, diagnosis, and management of spinal epidural abscess (SEA).Methods:Utilizing PubMed, we performed a comprehensive review of the literature on SEAs.Results:SEA remains a difficult infectious process to diagnose. This is particularly true in the early stages, when patients remain neurologically intact, and before the classic triad of fever, back pain, and neurologic deficit develop. However, knowledge of risk factors, obtaining serologic markers, and employing magnetic resonance scans facilitate obtaining a prompt and accurate diagnosis. In patients without neurologic deficits, lone medical therapy may prove effective.Conclusions:More prevalent over the previous three decades, SEA remains a rare but deleterious infectious process requiring prompt identification and treatment. Historically, identification of SEA is often elusive, diagnosis is delayed, and clinicians contend that surgical debridement is the cornerstone of treatment. Early surgery leads to more favorable outcomes and preserves neurologic function, particularly in the early stages of disease when minimal or no neurologic deficits are present. The advent of improved imaging modalities, diagnostic techniques, and multidrug antimicrobial agents has enabled medical/spinal surgical consultants to more rapidly diagnose SEA and institute more effective early medical treatment (e.g., data suggest that lone medical therapy may prove effective in the early management of SEA).

Timing and prognosis of surgery for spinal epidural abscess: A review

“…Avilucea and Patel assessed the literature/PubMed regarding organisms identified, and the diagnosis/management of SEA [ Table 4 ]. [ 6 ] Notably, it is difficult to establish this diagnosis before the triad of back pain, fever, and neurological deficit appear. Being familiar with other risk factors and obtaining diagnostic information earlier (e.g., lab studies, MRI) are critical and help direct whether medical versus surgical management will be warranted.…”

Alveolar soft part sarcoma: the new primary intracranial malignancy

“…An initial radiological diagnosis of meningioma was made in our case similarly to four of the other cases of primary intracranial ASPS. Typically, meningiomas are isointense to hypointense in comparison to grey matter on T1WI MRI with variable signal intensity on T2WI [19]. ASPS is most commonly known to be isointense to hyperintense on T1WI and characteristically hyperintense on T2WI, but this is in comparison to muscle [10].…”

“…Beyond its rarity, ASPS is also unusual in its characteristics of metastasis. Other high-grade soft tissue sarcomas rarely metastasize to the brain, whereas ASPS has a high metastatic potential and will involve the brain in up to 19% of cases [19]. To date, there are only ten cases of ASPS presenting with neurological symptoms, four of which had concomitant lung metastasis [4].…”