Rapidly progressive lumbar subdural empyema following acromial bursal injection

Coumans, Jean-Valéry; Walcott, Brian P.

doi:10.1016/j.jocn.2011.03.009

Cited by 16 publications

(15 citation statements)

References 11 publications

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“…4 This has been reported following epidural catheter insertion, discography, and lumbar puncture. 10,11 Infection can spread contiguously from the epidural space to the subdural region and can cause subdural empyema associated with cranial epidural abscess.…”

Section: Discussionmentioning

confidence: 98%

“…In reviewing the literature, there are three possible mechanisms for development of SSA. 4 Direct seeding of the infection into the subdural space was reported in association with a thoracic laminectomy complicated by an inadvertent durotomy. 5 In other reports, subdural empyema was associated with dermal sinus tracts [6][7][8] and decubitus ulcers.…”

Section: Discussionmentioning

confidence: 99%

“…12 The third likely mechanism for the spread of bacteria is hematogenous. 4 Subdural empyema has been reported after cervical acupuncture 13 and following meningitis. 4 In our patient negative blood cultures that were obtained before starting antibiotics and lack of systemic clinical signs of bacteremia make hematogenous spread unlikely.…”

Section: Discussionmentioning

confidence: 99%

“…4 Subdural empyema has been reported after cervical acupuncture 13 and following meningitis. 4 In our patient negative blood cultures that were obtained before starting antibiotics and lack of systemic clinical signs of bacteremia make hematogenous spread unlikely. Based on his decision to proceed with palliative care, antibiotics were stopped after he had received only one dose.…”

Section: Discussionmentioning

confidence: 99%

“…Those cases described the same discrepancy between the MRI findings of epidural collection and autopsy findings of subdural collection that we observed in our patient. 2,4 Inflammatory markers such as erythrocyte sedimentation rate and C-reactive protein, as well as leukocyte count can be in the normal range, making them not sensitive indicators of spinal infections. 3,9,15 SSA may cause rapid compression of the spinal cord and represents an extreme medical and neurosurgical emergency.…”

Section: Discussionmentioning

confidence: 99%

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Spinal Subdural Abscess: A Rare Complication of Decubitus Ulcer

Usoltseva

Medina‐Flores

Rehman

et al. 2014

Clinical Medicine & Research

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A male patient, aged 55 years, presented to the emergency room with complaints of bilateral upper extremity weakness. His past medical history was significant for paraplegia and neurogenic bladder from a spinal cord injury, complicated with decubitus ulcers and end-stage renal disease secondary to type II diabetes mellitus. His past surgical history was significant for posterior spine fusion with Harrington rod instrumentation at the level of T10. He developed subacute onset of bilateral upper extremity weakness and paresthesias on the day of presentation. He reported a 2-day history of neck and back pain that he initially contributed to his bedridden state. The patient denied fever, recent infections, or trauma. His vital signs were unremarkable. Physical examination revealed quadriparesis, absence of deep tendon reflexes, hypoesthesia, and decubitus ulcers (figure 1). He had a normal leukocyte count and elevated C-reactive protein. Blood cultures and cultures from the ulcers were obtained. With the concern of spinal cord compression based on presentation, intravenous corticosteroids and broad spectrum antibiotics were initiated. A magnetic resonance imaging (MRI) scan of the spine (figure 2) revealed large elongated epidural collection posteriorly within the cervical spine, extending into the thoracic spine and inferiorly. Spinal cord compression was prominent in the narrowed areas of disc-osteophyte complexes at the levels of C3-4 and C5-6, where the spinal cord was compressed between these disc-osteophyte complexes and the posterior epidural collection, with some mildly increased signal intensity within the cord. The lumbosacral spine was not well imaged due to artifacts of spinal hardware. Emergent drainage of the collection was indicated, but the patient declined. Per the patient's wishes, palliative care was initiated on the day Spinal subdural abscess (SSA) is an uncommon entity. The exact incidence is unknown, with very few cases reported in the literature. This condition may result in spinal cord compression, thus constituting a medical and neurosurgical emergency. The pathogenesis of SSA is not welldescribed, and the available knowledge is based on case observations only. There is only one case report that describes direct seeding from decubitus ulcers as a possible mechanism for development of SSA. We report a case of subacute onset of quadriplegia in a male patient, age 55 years, due to spinal cord compression from SSA and superimposed spinal subdural hematoma. The direct seeding from decubitus ulcers is thought to be the cause of infection in our patient. We present this case of SSA to elucidate and review the predisposing factors, pathogenesis, clinical presentation, diagnostic modalities, and treatment regarding management of this rare disorder.

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Section: Discussionmentioning

confidence: 98%