Spinal Epidural Abscess

Krishnamohan, Prashanth; Berger, Joseph

doi:10.1007/s11908-014-0436-7

Cited by 37 publications

(34 citation statements)

References 60 publications

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“…SEA is not a typical diagnosis in patients presenting with chest pain, especially in a patient with known coronary artery disease and recent stent placement. A recent meta-analysis reported incidence of 2–3 cases of SEA per 10 000 hospital admissions, an increase over the incidence reported in retrospective studies from 1990, which spanned 10 years 1 2. This increase in the incidence of SEA may be attributed to a number of factors, including better neuroimaging capabilities, improved disease awareness, an increased number of elderly and immunocompromised patients and growing rates of illicit drug abuse 3.…”

Section: Discussionmentioning

confidence: 99%

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Catastrophic chest pain: blinded by cardiopulmonary disease

et al. 2015

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A 53-year-old man with a history of diabetic foot ulcer, osteomyelitis, coronary artery disease, hypertension and hyperlipidaemia, presented with chest pain of 3 weeks duration. Eleven days earlier, the patient had had a drug-eluting stent (DES) placed in a branch of the right coronary artery (RCA) after similar chest pain, leading to the findings of a positive nuclear stress test. Since discharge, he was not compliant with taking clopidegrel (Plavix), a concern for in-stent thrombosis with recurrent myocardial ischaemia; but work up was negative and medications were restarted. Within 24 h of admission, he developed bilateral flaccid leg weakness, urine retention and loss of sensation from the umbilicus level down. MRI revealed a T4-T6 epidural abscess. Emergent decompression laminectomy and abscess drainage was completed. Neurological symptoms improved hours after surgery with complete resolution of sensory deficits. Cultures grew Streptococcus sp., treated with intravenous nafcillin for 8 weeks. He regained leg strength with continued improvement seen in rehabilitation.

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Section: Discussionmentioning

confidence: 99%

“…Spinal epidural abscess (SEA) is a suppurative infection localised to the extradural space,1 which commonly presents with back pain. SEA is not a typical diagnosis in patients presenting with chest pain, especially in a patient with known coronary artery disease and recent stent placement.…”

Section: Discussionmentioning

confidence: 99%

Catastrophic chest pain: blinded by cardiopulmonary disease

et al. 2015

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“…CT with IV contrast can be considered as myelogram is not common anymore but it may not distinguish early infectious findings from other changes involving the soft tissues, discs, or vertebrae. 9 Treatment is both medical and surgical. Empirical antibiotic regimen can be vancomycin, metronidazole and third generation cephalosporin or vancomycin and piperacillin-tazobactam among other combinations.…”

Section: Diagnosismentioning

confidence: 99%

Epidural abscess assessment and management

Ali¹

2017

Int J Res Med Sci

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Epidural abscess is a medical emergency. Abscesses can expand to compress the brain or spinal cord and cause severe symptoms, perma-nent neurological deficits, or even death. Most spinal epidural abscesses begin as focal pyogenic infection involving the vertebral disc or junction between the disc and the vertebral body and as inflammation pro-gresses, abscess may extend longitudinally in the epidural space, and damage to the spinal cord can happen. Symptoms on presentation may include fever, malaise, back pain, motor weakness, sensory changes, bladder or bowel dysfunction, or paralysis. Most important diagnostic test is MRI because it is positive early in the course of the infection and pro-vides the best visualization of the location and extent of inflammatory changes. MRI with contrast should be performed as soon as possible. Treatment is both medical and surgical. Empirical antibiotic regimen can be vancomycin, metronidazole and third generation cephalosporin or vancomycin and piperacillin-tazobactam among other combinations. Fur-ther guidance by infectious work up. After diagnosis, neurosurgery con-sultation is taken immediately for surgical evaluation and management.

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“…12 Because of the pervasive nature of neck and back pain, misdiagnosis of SEA on initial presentation is noteworthy, with estimates ranging from 11% to 75%. 7,13 A SEA, on average, crosses 3.85 vertebral levels and is reported in the thoracic (15%-39.1%), lumbosacral (30%-54.7%), and cervical (9%-35.9%) regions. 6,7,14,15 Magnetic resonance imaging (MRI) examination with and without gadolinium of the entire spine is the gold standard, as it differentiates SEA from other space-occupying lesions and malignancy.…”

Section: Introductionmentioning

confidence: 99%

“…5,11,15 The infectious agent causing SEA is most commonly of bacterial origin and overwhelmingly either methicillin-sensitive or methicillin-resistant Staphylococcus aureus. 7,13 Once patients are diagnosed with SEA, best outcomes are achieved with rapid surgical intervention, abscess drainage, and concomitant antibiotic treatment. When monitored closely for clinical deterioration, there are select cases with limited neurological deficit that may be managed with antibiotic therapy only.…”

Section: Introductionmentioning

confidence: 99%

Thoracic Spondylodiscitis Epidural Abscess in an Afebrile Navy Veteran: A Case Report

Cupler

Anderson

Stancik

2017

Journal of Chiropractic Medicine

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Objective: The purpose of this case study was to describe the differential diagnosis of a thoracic epidural abscess in a Navy veteran who presented to a chiropractic clinic for evaluation and management with acupuncture within a Veterans Affairs Medical Center. Clinical Features: An afebrile 59-year-old man with acute thoracic spine pain and chronic low back pain presented to the chiropractic clinic at a Veterans Affairs Medical Center for consideration for acupuncture treatment. Intervention and Outcome: The veteran elected to trial acupuncture once per week for 4 weeks. A routine thoracic magnetic resonance imaging scan without gadolinium detected a space-occupying lesion after the patient failed to attain 50% reduction of pain within 2 weeks with conservative care. The patient was diagnosed with a multilevel thoracic spondylodiscitis epidural abscess and was treated same day with emergency debridement and laminectomy of T7-8 with a T6-9 fusion. The patient had complete recovery without neurological compromise and completed an antibiotic regimen for 6 weeks. Conclusion: A Navy veteran with acute thoracic spine and chronic low back pain appeared to respond initially but failed to achieve clinically meaningful outcomes. Follow-up advanced imaging detected a thoracic spondylodiscitis epidural abscess. Early diagnosis and immediate intervention are important to preserving neurological function and limiting morbidity in cases of spondylodiscitis epidural abscess. (J Chiropr Med 2017;16:246-251)

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Spinal Epidural Abscess

Cited by 37 publications

References 60 publications

Catastrophic chest pain: blinded by cardiopulmonary disease

Catastrophic chest pain: blinded by cardiopulmonary disease

Epidural abscess assessment and management

Thoracic Spondylodiscitis Epidural Abscess in an Afebrile Navy Veteran: A Case Report

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