Subdural Empyema Combined with Paraspinal Abscess After Epidural Catheter Insertion

Volk, Thomas; Hebecker, R; Ruecker, Gerta; Perka, Carsten; Haas, N. A.; Spies, Claudia

doi:10.1213/01.ane.0000149040.54969.b4

Cited by 21 publications

(9 citation statements)

References 2 publications

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“…To date, only 58 SSA cases have been reported (including our case) (1–3, 8–16). A review of these 58 cases revealed S. aureus as the most frequent causative agent (Table 1), and the most frequent localization of SSA was the lumbar region (Table 2).…”

Section: Discussionmentioning

confidence: 97%

“…Typical symptoms of SSA are fever, back pain or root pain, spinal symptoms such as para/tetraparesis, bladder dysfunctions, disturbances of consciousness and general inflammatory signs (1, 3, 17). Spinal tenderness is not seen in SSA in contrast to spinal epidural abscess (15). Our patient demonstrated paraparesia after a history of low back pain, and in the course of time she developed paraplegia and diparesia with bowel and urinary incontinence.…”

Section: Discussionmentioning

confidence: 99%

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Spinal subdural Staphylococcus aureus abscess: case report and review of the literature

Vural¹,

Arslantaş²,

Adapınar³

et al. 2005

Acta Neurol Scand

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Spinal subdural abscesses (SSA) are rare and to date only 57 cases have been reported. The exact incidence of the SSA is unknown. The most affected region is the thoraco-lumbar spine and the most common bacterial source is Staphylococcus aureus. The timing for magnetic resonance imaging is very important in these patients. Because early diagnosis and emergent treatment is vital to prevent the formation or progression of neurologic deficits.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Spinal subdural Staphylococcus aureus abscess: case report and review of the literature

Vural¹,

Arslantaş²,

Adapınar³

et al. 2005

Acta Neurol Scand

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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. 10 A case of extension of a retropharyngeal abscess into the subdural space has been described.…”

Section: Discussionmentioning

confidence: 99%

“…Contrast-enhanced MRI is superior in detecting the exact location, extension of the abscess, and in diagnosing spinal cord compression. 11,[15][16][17] Although MRI is the most powerful diagnostic tool, SSA is a surgical diagnosis, because it may be Spinal subdural abscess difficult to correctly differentiate epidural from subdural infection. Based on a literature review, there are two case reports where radiographic findings lagged behind the clinical presentation.…”

Section: Discussionmentioning

confidence: 99%

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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“…A primary cause was not identified in this case. Epidural empyema has been associated with discospondylitis in dogs (Lavely and others 2006) and in man with discospondylitis, systemic infection, spinal injections (Mauer and Kunz 2006) and epidural catheter insertion (Volk and others 2005). Whether the infection in this case originated from the spinal canal or the retroperitoneal space is unclear.…”

Section: Discussionmentioning

confidence: 99%

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Gemmill

2008

J of Small Animal Practice

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Subdural Empyema Combined with Paraspinal Abscess After Epidural Catheter Insertion

Cited by 21 publications

References 2 publications

Spinal subdural Staphylococcus aureus abscess: case report and review of the literature

Spinal subdural Staphylococcus aureus abscess: case report and review of the literature

Spinal Subdural Abscess: A Rare Complication of Decubitus Ulcer

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