Case Of Spinal Epidural Abscess Research Articles

Intraoperative Cardiovascular Emergency in Spinal Melioidosis Presenting as a Case of Spinal Epidural Abscess: A Rare Case Study of 2 Patients

Intraoperative Cardiovascular Emergency in Spinal Melioidosis Presenting as a Case of Spinal Epidural Abscess: A Rare Case Study of 2 Patients

A Rare Cause of Epidural Abscess: Esophageal Perforation After Radiotherapy

Introduction:
 Spinal epidural abscess is a rare neurosurgical emergency that is usually seen invasive interventions to the spinal region, trauma or infection. In our case, anteriorly located spinal epidural abscess, which is caused by spontaneous esophageal rupture as complication of radiotherapy, is described.
 Case report:
 A 60-year-old female patient was admitted to the emergency department with complaints of confusion, high fever and weakness in both legs. The patient had been treated for lung metastasis of breast cancer with radiotherapy. Spinal anterior epidural abscess was observed in the spinal imaging, and it was considered that the abscess developed after esophageal rupture secondary to radiotherapy. After surgery the patient had antibiotic treatment during the postoperative period. Although there are cases of spinal epidural abscess that developed after esophageal rupture in the literature, they were generally observed after interventions to the esophagus or trauma to the chest. In our case, epidural abscess developed after radiotherapy, that caused esophageal rupture, was presented.
 Conclusion:
 Clinicians should consider spinal epidural abscess, which is a rare complication in patients with walking difficulties after radiotherapy, in the differential diagnosis.

Spinal epidural abscess in COVID-19 patients.

ObjectiveTo report the peculiarity of spinal epidural abscess in COVID-19 patients, as we have observed an unusually high number of these patients following the outbreak of SARS-Corona Virus-2.MethodsWe reviewed the clinical documentation of six consecutive COVID-19 patients with primary spinal epidural abscess that we surgically managed over a 2-month period. These cases were analyzed for what concerns both the viral infection and the spinal abscess.ResultsThe abscesses were primary in all cases indicating that no evident infective source was found. A primary abscess represents the rarest form of spinal epidural abscess, which is usually secondary to invasive procedures or spread from adjacent infective sites, such as spondylodiscitis, generally occurring in patients with diabetes, obesity, cancer, or other chronic diseases.In all cases, there was mild lymphopenia but the spinal abscess occurred regardless of the severity of the viral disease, immunologic state, or presence of bacteremia. Obesity was the only risk factor and was reported in two patients. All patients but one were hypertensive. The preferred localizations were cervical and thoracic, whereas classic abscess generally occur at the lumbar level. No patient had a history of pyogenic infection, even though previous asymptomatic bacterial contaminations were reported in three cases.ConclusionWe wonder about the concentration of this uncommon disease in such a short period. To our knowledge, cases of spinal epidural abscess in COVID-19 patients have not been reported to date. We hypothesize that, in our patients, the spinal infection could have depended on the coexistence of an initially asymptomatic bacterial contamination. The well-known COVID-19-related endotheliitis might have created the conditions for retrograde bacterial invasion to the correspondent spinal epidural space.Furthermore, spinal epidural abscess carries a significantly high morbidity and mortality. It is difficult to diagnose, especially in compromised COVID-19 patients but should be kept in mind as early diagnosis and treatment are crucial.

A rare case of spinal epidural abscess: diagnostic challenges and rehabilitation outcomes

Introduction: Spinal epidural abscess is a rare clinical entity with considerable morbidity. Even with prompt diagnosis and treatment, many patients are left with persistent residual neurological deficits. Case report: The purpose of this article is to report a rare case of primary pyogenic spinal epidural abscess. The patient admitted to our clinic because of lumbar pain of increasing severity and fever. Case management consisted of surgical and medical treatment with antibiotics. Postoperatively, with proper rehabilitation program, he markedly improved. Conclusions: Despite a correct management, spinal epidural abscess is associated with a high degree of morbidity and mortality. Proper treatment, rehabilitation programs and long-term follow-up is critical for a better outcome.

Studies on 11 Cases of Spinal Epidural Abscess and Literature Review.

ObjectiveIn the present study, we aimed to describe the clinical features, diagnosis, treatment, and prognosis of spinal epidural abscess (SEA).MethodsThe complete clinical data of 11 SEA patients who were treated in our hospital system from January 2015 to June 2018 were retrospectively analyzed. Moreover, the clinical features, diagnosis, treatment, and prognosis of 642 SEA cases collected from the foreign literature from 2010 to 2019 were also investigated.ResultsAmong our 11 SEA patients, nine cases had purulent inflammation, two cases had tuberculosis, two cases had infection caused by Staphylococcus aureus, one case had infection caused by Streptococcus constellatus, one case had infection caused by Klebsiella pneumoniae, five cases showed negative bacterial culture, and two cases had Mycobacterium tuberculosis. All 11 cases showed focal spinal pain, eight cases exhibited neurological deficits, and six cases experienced fever. Nine of the 11 cases involved the lumbosacral spine, one case involved the thoracic spine, and one case involved the cervical spine. Eight patients had a longer course of disease (>2 weeks), all 11 patients had vertebral osteomyelitis, and nine patients had intervertebral discitis. One patient had motor dysfunction of arms and legs, one patient had lower limb motor dysfunction, one patient had limb numbness, one patient experienced relapse after the conservative treatment, and one patient experienced relapse after the surgical treatment. The follow-up time was 15–24 months.ConclusionThe classic diagnosis of triads (focal spine pain, neurological deficit, and fever) was less specific for SEA. MRI examination, blood culture, tissue culture, and biopsy could be used for the diagnosis for SEA. Suppuritis was a common cause of SEA. Early detection, early diagnosis and early treatment, as well as the selection of the most suitable treatment regimen based on comprehensive evaluation, played crucial roles in a better prognosis of SEA. There was no statistically significant difference in terms of the general condition, diagnosis, treatment and prognosis between the patients with negative and positive culture results (P>0.05). For SEA patient with negative culture, antibiotic treatment should be used empirically.

A case of spinal epidural abscess in which MRI diffusion weighted imaging was useful for diagnosis

A case of spinal epidural abscess in which MRI diffusion weighted imaging was useful for diagnosis

Our institutional experience with Spinal Epidural Abscess

CorrigendumThe article published in Nepal Journal of Neurosciences 2019;16:16-19 by Joulali Youssef etal was mistakenlypublished with a wrong co-author.The corresponding author has submitted following authors as responsible for the article, Y. Joulali, F. Lakhdar,M. Benzagmout, K. Chakour and M.F. Chaoui. Bipin Chaurasia was added in error.Please cite this article as Joulali Y, Lakhdar F, Benzagmout M, Chakour K, Chaoui MF. Our institutionalexperience with Spinal Epidural Abscess. Nepal Journal of Neurosciences 2019 ; 16:16-19 in future citations.
 Abstract: Spinal epidural abscess is a rare pathology which is manifested by a classic triad of pain, fever and neurological deficit. In most cases, the clinical picture is incomplete which makes its diagnosis difficult. In this retrospective study, we report five cases of spinal epidural abscess treated in the neurosurgery department of Hassan II University Hospital of Fez. Four of our patients were admitted due to spinal cord compression, while one patient was admitted for isolated spinal syndrome without neurological deficit. Fever was present in all our patients, nevertheless no point of entry was identified in the initial assessment. MRI was performed on emergency basis in all of our patients which demonstrated an extra-dural hypo intensity on T1WI, hyper intensity on T2WI. It also showed lesions with peripheral enhancement after contrast with gadolinium. Four of our patients underwent surgical treatment which involved performing alaminectomy/laminotomy with drainage of the abscess, while one patient received medical treatment alone. The evolution was favorable in 4 of our patients while one patient died post operatively due to severe sepsis.

Spinal epidural abscess caused by Pasteurella multocida mimicking aortic dissection: a case report

BackgroundPasteurella multocida (P. multocida) forms part of the normal flora of many animals. Although it is a common causative agent of skin and soft tissue infection after an animal bite or scratch, in rare cases it can cause spinal infections in humans.Case presentationA 68-year-old immunocompetent woman presented with fever and sudden onset of severe back pain mimicking aortic dissection. No findings related to the pain were revealed on enhanced computed tomography or initial magnetic resonance imaging (MRI) of the spine. The patient was found to be bacteremic with P. multocida, although she had no apparent injury related to animal contact. Repeated evaluation by MRI with gadolinium-contrast established the diagnosis of spinal epidural abscess. The patient was cured by the rapid initiation of antimicrobial therapy without surgery.ConclusionsWe describe the successful treatment of an individual with a spinal epidural abscess due to P. multocida without surgery. P. multocida infections may occur as sudden presentations. Obtaining the patient history of recent animal contact is essential. Repeated MRI evaluation may be required when spinal infections are suspected. To the best of our knowledge, this is the first report which describes a case of spinal epidural abscess due to this organism.

Spinal Epidural Abscess Diagnosed at Lumbar Puncture Tap and Revealed by Paraparesis

Spinal epidural abscess (SEA) is a deadly disease if not promptly treated with antibiotics, either in association with neurosurgery or not. Motor impairment remains the most complication, but death can occur particularly in a resource-limited setting. We report a case of spinal epidural abscess in a 56-year-old female in an urban setting in Cameroon complicated motor impairment. She presented with a 1-week history of back pain and pollakiuria. The diagnosis was done by a lumbar puncture tap. Despite an improvement in the availability of diagnostic and therapeutic modalities for neurologic emergencies, affordability is still a challenge. An increase in our technical platform and accessibility of anyone to care remain a big challenge in sub-Saharan Africa.

Spinal epidural abscess caused by Gardnerella vaginalis and Prevotella amnii.

We report a case of spinal epidural abscess (SEA) in a 58-year-old woman who had recently been diagnosed with gonococcal infection, but did not receive guideline-recommended therapy. She presented with back pain and signs and symptoms of pelvic inflammatory disease (PID). MRI of the spine demonstrated epidural abscess extending from L4-L5 to T10. She underwent T10-L1 and L3-L4 laminectomies for evacuation of the abscess and Gardnerella vaginalis and Prevotella amnii were isolated from the abscess fluid cultures. Our case demonstrates SEA as a rare, but morbid complication of PID and highlights the pathogenic potential of the anaerobic flora associated with PID.

Spinal epidural abscess: a rare complication of ulcerative colitis after ileal pouch anal anastomosis.

BackgroundSpinal epidural abscess is a rare condition with high morbidity and mortality, for which a delay in diagnosis and treatment can lead to irreversible neurologic deficit or even death. Although patients with spinal epidural abscess have systemic predisposing immunocompromised conditions, spinal intervention, or trauma, this condition has been reported as a result of perforation or fistulization arising from inflammatory bowel disease. We describe herein a rare case of spinal epidural abscess as a complication of ileal pouch anal anastomosis.Case presentationA 37-year-old man who had previously undergone restorative proctocolectomy and ileal pouch anal anastomosis for ulcerative colitis presented with complaints of persistent low-grade fever and lumbago with unusual sensation in the lower legs. After evaluation by Gastrografin contrast radiography, computed tomography, and magnetic resonance imaging, he was diagnosed with a spinal epidural abscess extending from L5 to S1. In addition, the abscess communicated with the ileal pouch. He underwent surgical drainage of the abscess, excision of the fistula, and defunctioning ileostomy. Although a second operation for drainage was required for residual presacral abscess, there was no sign of recurrence of the spinal epidural abscess. He eventually was able to close his stoma.ConclusionsAlthough spinal epidural abscess is a rare complication, one should take this condition into account when patients complain of back pain or neurologic symptoms of the lower extremities, given the possibility of fistulous communication between the ileal pouch and spine.

P.134 Spinal epidural abscess associated with septic facet joints-one center experience

Background: Infection to the facet joints has been reported sporadically but the significance of this type of infection has not been clarified. In our study on spine infection, we identified the cases of spinal epidural abscess with septic joints and was able to compare to cases of epidural abscess with discitis and osteomyelitis. Methods: Between 2007 and 2014, we experienced 176 cases of spine infection including discitis, osteomyelitis and epidural abscess. Retrospective review of the clinical data and radiological findings was performed. Among 176 cases, 80 patients had epidural abscess. They were divided to two groups, one with septic joint and the other with discitis and osteomyelitis. Results: 23 patients were found to have septic joints with epidural abscess based on the MRI findings. Mean age was 45.5. 15 of 23 patients (65%) required surgery and all treated with laminectomy. 78% had a good neurological outcome.57 patients had epidural abscess with discitis and osteomyelitis. Mean age was 54. 51% required surgery. Only 62 % was treated with laminectomy alone. Good neurological outcome was seen in 67% of the patients. Conclusions: Infected facet joints are not as rare as generally believed. The patients with septic joints are younger. Surgery was done more often and laminectomy provided better neurological outcome

Medical treatment of a spinal epidural abscess with neurologic deficits.

In spite of advances in medical knowledge, imaging techniques, and surgical interventions, the diagnosis and treatment of spinal epidural abscess remains a challenge. The diagnosis is often elusive, but achieving diagnosis prior to the onset of neurological deficits is essential to preserving the vital neurological function. Traditionally, urgent surgical decompression and drainage remain the mainstay therapy for spinal epidural abscess. In recent years, with the improvement of antibiotics, conservative treatment with adequate antibiotics has been proposed as an effective method in selective patients. We report a case of spinal epidural abscess in a 50-year-old man, who complained of progressive weakness of lower extremities for 4 days before admission. After conservative treatment with antibiotics alone, the patient recovered uneventfully from previous neurological deficits. The relevant literature is also reviewed.

Intradural Extension of a Pyogenic Epidural Abscess: A Case Report.

Few cases of spinal epidural abscess involving an extradural abscess with an intradural extension have been reported. A unique complication with extension of pus from the epidural space through multiple perforations into the dura is described. Due to a proximal meningeal inflammatory reaction, which served as a proximal plug, no cerebrospinal fluid leak was encountered. Intradural extension of pus through multiple dural perforations is a rare complication of spinal epidural abscess and a treatment challenge. Early diagnosis enabling prompt surgical decompression, along with subsequent aggressive debridements and prolonged intravenous antibiotic treatment, can lead to a favorable outcome.

Flare Up of Brucella Infection with Formation of Epidural Abscess After Lumbar Fusion; Report of Two Cases

Brucellar spinal infection remains a common health problem in the Middle East. Brucella infection may be difficult to diagnose due to non specific symptoms and signs, this may lead to perioperative complications after spinal surgery. We report two cases of spinal epidural abscess after posterior lumbar decompression and fusion. They were a 35-year male patient and a 48-year female patient underwent posterior lumbar decompression and fusion for multiple degenerative disc herniations. One month after surgery and after sound wound healing both patients complained of low back pain with noticeable swelling at the surgical site without neurological deficit. MRI of the lumbar spine revealed lumbar epidural abscess. Wound exploration with abscess drainage revealed no foreign body with characteristic discharge. Brucellin test was positive for both patient and received anti-brucellar drugs for 3 months. Both patients had a smooth postoperative course after drainage of the abscess and application of antimicrobial therapy.

A case of spinal epidural abscess caused by MRSA

A case of spinal epidural abscess caused by MRSA

Two Cases of Spinal Epidural Abscess in Hemodialysis Patients

While epidural abscesses are rare in hemodialysis patients, they can cause severe neurological complications that can be fatal because only nonspecific symptoms appear in the early stages of the infection. Their incidence increased recently due to intravenous drug abuse, invasive spinal surgery, percutaneous vertebral procedures, and the development of diagnostic modalities. The increased number of cases is related to the use of dialysis catheters in hemodialysis patients. If a patient has fever and back pain, doctors should eliminate the possibility of other common diseases and consider spinal epidural infection. Early diagnosis and proper treatment are important to prevent neurological complications. In this paper, the symptoms, blood work, magnetic resonanceimaging (MRI) findings, and clinical course of two hemodialysis patients who developed spinal epidural abscesses are described.

A Case of Epidural Abscess Occurred after Liver Abscess Complicated by Transarterial Chemoembolization in a Patient with Metastatic Cancer to Liver

Transarterial chemoembolization (TACE) is one of the most effective therapies for unresectable hepatocelluar carcinoma or metastatic hypervascular tumors. Abscess occurring in the other organs beside the liver after TACE is a complication that often occurs, sometimes potentially fatal. We report a case of spinal epidural abscess occurred after liver abscess complicated by TACE in a patient with metastatic neuroendocrine tumors to the liver. A 67-year-old female underwent TACE first for the metastatic lesions to liver, with a history of pancreatoduodenectomy for the primary pancreatic neuroendocrine tumor. Four days after TACE, sudden high fever occurred, and liver abscess was found on abdominal CT. Two days later, back pain and radiating pain to the right leg occurred, and lumbar spine MRI showed spinal epidural abscess. After intravenous antibiotics for 8 weeks and partial laminectomy, the patient recovered and was discharged without complications.

Medicolegal Cases for Spinal Epidural Hematoma and Spinal Epidural Abscess

Spinal epidural hematoma and spinal epidural abscess are rare surgical emergencies resulting in significant neurologic deficits. Making the diagnosis for spinal epidural hematoma and spinal epidural abscess can be challenging; however, a delay in recognition and treatment can be devastating. The objective of this retrospective analysis study was to identify risk factors for an adverse outcome for the provider. The LexisNexis Academic legal search database was used to identify a total of 19 cases of spinal epidural hematoma and spinal epidural abscess filed against medical providers. Outcome data on trial verdicts, age, sex, initial site of injury, time to consultation, time to appropriate imaging studies, time to surgery, and whether a rectal examination was performed or not were recorded. The results demonstrated a significant association between time to surgery more than 48 hours and an unfavorable verdict for the provider. The degree of permanent neurologic impairment did not appear to affect the verdicts. Fifty-eight percent of the cases did not present with an initial deficit, including loss of bowel or bladder control. All medical professionals must maintain a high level of suspicion and act quickly. Physicians who are able to identify early clinical features, appropriately image, and treat within a 48 hour time frame have demonstrated a more favorable medicolegal outcome compared with their counterparts in filed lawsuits for spinal epidural hematoma and spinal epidural abscess cases.

3 cases of spinal epidural abscess which treated by surgery

3 cases of spinal epidural abscess which treated by surgery