scholarly journals Insidious Onset of Tetraparesis due to Cervical Epidural Abscess fromEnterococcus faecalis

2013 ◽  
Vol 2013 ◽  
pp. 1-5
Author(s):  
Konstantinos Chr. Soultanis ◽  
Vasileios I. Sakellariou ◽  
Konstantinos A. Starantzis ◽  
Nikolaos A. Stavropoulos ◽  
Panayiotis J. Papagelopoulos
Keyword(s):  
Epidural Abscess ◽  
Clinical Laboratory ◽  
Correct Diagnosis ◽  
Cervical Disc ◽  
Spinal Epidural Abscess ◽  
Neurological Improvement ◽  
Insidious Onset ◽  
Upper And Lower Extremities ◽  
Clinical Triad ◽  
High Index Of Suspicion

We report a case of cervical epidural abscess fromEnterococcus faecalis, which caused an insidious onset of tetraparesis. This 53-year-old female with a history of diabetes mellitus and chronic renal failure under hemodialysis presented with pain and progressive weakness of upper and lower extremities without fever. Although a recent MRI she did at the beginning of symptoms showed no significant pathologies, except for a cervical disc herniation and adjacent spinal degeneration, and stenosis that confused the diagnostic procedure, newer imaging with CT and MRI, which was performed due to progression of tetraparesis, revealed the formation of a cervical epidural abscess. Surgical drainage was done after a complete infection workup. The patient showed immediate neurological improvement after surgery. She received antibiotics intravenously for 3 weeks and orally for another 6 weeks. The patient was free from complications 24 months after surgery. A high index of suspicion is most important in making a rapid and correct diagnosis of spinal epidural abscess. The classic clinical triad (fever, local pain, and neurologic deficits) is not sensitive enough for early detection. Continuous clinical, laboratory, and imaging monitoring are of paramount importance. Early diagnosis and surgical intervention could optimize the final functional outcome.

scholarly journals Recurrence of spinal epidural abscess after inadequate antibiotic dosage regimen

2019 ◽  
Vol 1 (1) ◽  
pp. 66-69
Author(s):  
Ram Krishna Dahal ◽  
Javad Ahmad Khan ◽  
Binod Bijukachhe
Keyword(s):  
Back Pain ◽  
Neurological Deficit ◽  
Epidural Abscess ◽  
Blood Parameters ◽  
Surgical Decompression ◽  
Clinical Suspicion ◽  
Spinal Epidural Abscess ◽  
Threatening Condition ◽  
Clinical Triad ◽  
Spinal Epidural

Introduction: Spinal epidural abscess (SEA) is a potentially life threatening condition which can present with a clinical triad of fever, back pain and neurological deficit. It is more common in elderly population with risk factors like immunocompromised status, diabetes mellitus and alcoholism. High index of clinical suspicion of SEA warrants prompt investigated and treatment. Immediate surgical decompression along with antibiotic is recommended for better outcome. Case Presentation : A 16 years old boy presented with complaints of fever, upper back pain which had developed gradually over a period of 10 days. He had history of furuncle in perineal region 3 weeks prior to his symptoms, which was drained. With high clinical suspicion of SEA, Contrast enhanced Magnetic Resonance Imaging (CEMRI) was done along with blood parameters and was diagnosed as SEA D3-D6 level. He underwent immediate surgical decompression and was given 3 weeks of antibiotics. Post-operative period was uneventful with clinical improvement of the symptoms. He again presented to us with relapse of the infection on 28th post-operative day with similar fever and back pain. He was reinvestigated with MRI and blood investigations which revealed relapse of the infection. He was then managed with intravenous (IV) Vancomycin for 2 weeks and oral Erythromycin for another 6 weeks. He did not require any surgical intervention in his later presentation. Conclusion: Spinal epidural abscess is a surgical emergency and prompt diagnosis with surgical drainage is recommended for better outcome even when there is no neurological deficit. Abscess drainage should be adjunct with longer duration of antibiotics for at least 6 weeks for optimum results.

scholarly journals Susac's Syndrome in a Patient Diagnosed with MS for 20 Years: A Case Report

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Bijen Nazliel ◽  
Asli Akyol ◽  
Hale Zeynep Batur Caglayan ◽  
Irem Yildirim-Capraz ◽  
Ceyla Irkec
Keyword(s):  
Hearing Loss ◽  
Vision Loss ◽  
Correct Diagnosis ◽  
Sensorineural Deafness ◽  
Active Phase ◽  
Susac’S Syndrome ◽  
Subacute Dementia ◽  
Appropriate Therapy ◽  
Clinical Triad ◽  
High Index Of Suspicion

Susac’s syndrome is an uncommon neurologic disorder of unknown cause. It has been described as a clinical triad of encephalopathy, hearing loss, and branch retinal artery occlusions. Clinically the diagnosis is difficult when the patient presents only a portion of a triad. We present a case with vision loss and sensorineural deafness and who had been diagnosed with MS for 20 years. Susac’s syndrome is presumed to be an autoimmune endotheliopathy. Neurologic symptoms and signs are diffuse and multifocal, acute or subacute in onset, and progress during the active phase of the disease. In some patients the onset was stroke like and in others that of subacute dementia. Headache, often with migrainous features, was a prominent feature initially in more than one half of the patients. A high index of suspicion leading to correct diagnosis and early appropriate therapy may reduce the permanent sequel seen with this disease. Misdiagnosis is common. In patients in whom diagnosis and treatment are delayed permanent morbidity is higher in terms of visual loss, hearing loss, and neurologic debility. In patients in whom rapid diagnosis has led to early administration of immunosuppressive therapy, recovery can be almost complete.

scholarly journals Spinal Epidural Infection

1979 ◽  
Vol 6 (3) ◽  
pp. 325-328 ◽  
Author(s):  
N.A. Russell ◽  
Richard Vaughan ◽  
T.P. Morley
Keyword(s):  
Surgical Treatment ◽  
Epidural Abscess ◽  
Correct Diagnosis ◽  
Spinal Epidural Abscess ◽  
Results Of Treatment ◽  
Mode Of Presentation ◽  
Complete Paralysis ◽  
Spinal Epidural

SUMMARY:Thirty cases of spinal epidural abscess are reviewed with particular emphasis on mode of presentation and results of treatment. In spite of repeated exhortations in the literature for earlier diagnosis, the results remain unsatisfactory because many patients have progressed to severe or complete paralysis before the correct diagnosis is made and surgical treatment carried out.

Cervical brucellar spondylodiscitis mimicking a cervical disc herniation with epidural abscess: a case report

2014 ◽  
Vol 0 (0) ◽  
Author(s):  
Ahmet Aslan ◽  
Ünal Kurtoğlu ◽  
Mustafa Özgür Akça ◽  
Sinan Tan ◽  
Uğur Soylu ◽  
...  
Keyword(s):  
Case Report ◽  
Disc Herniation ◽  
Epidural Abscess ◽  
Cervical Disc Herniation ◽  
Cervical Disc

Aggregatibacter aphrophilus spinal epidural abscess

2020 ◽  
Vol 13 (7) ◽  
pp. e235320
Author(s):  
Antoine Altdorfer ◽  
Pierre Gavage ◽  
Filip Moerman
Keyword(s):  
Risk Factors ◽  
Lower Limb ◽  
Rare Case ◽  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Surgical Drainage ◽  
Eikenella Corrodens ◽  
Aggregatibacter Aphrophilus ◽  
Progressive Neurological Deficit ◽  
Spinal Epidural

A 76-year-old woman with a rare case of spinal epidural abscess (SEA) that had no risk factors for such type of infection, presented symptoms of back pain, progressive neurological deficit of the lower limb and loss of sphincter control. A gadolinium-enhanced MRI confirmed the diagnosis of an SEA. The patient underwent laminectomy with surgical drainage, where cultures showed the presence of Aggregatibacter aphrophilus, a bacterium of the HACEK group (Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species), rarely involved in SEA. Following surgery, the patient was treated with intravenous ceftriaxone for 6 weeks, and this gave excellent results.

Mycobacterium Fortuitum Infections of the Hand

1992 ◽  
Vol 17 (6) ◽  
pp. 675-677 ◽  
Author(s):  
F. K. IP ◽  
S. P. CHOW
Keyword(s):  
Correct Diagnosis ◽  
High Index ◽  
Mycobacterium Fortuitum ◽  
High Index Of Suspicion

Five cases are reported of infection due to Mycobactenum fortuitum involving the hand following contaminated injection or traumatic wounds. Synovectomy, debridement, or amputation together with prolonged chemotherapy using kanamycin or amikacin were required. Doxycycline and sulphamethoxasole also seemed to be the effective antibiotics for this organism. A high index of suspicion is important in order to obtain the correct diagnosis.

Epidural Lipomatosis Simulating an Epidural Abscess: Case Report and Literature Review

Neurosurgery ◽  
1987 ◽  
Vol 21 (5) ◽  
pp. 744-747 ◽  
Author(s):  
Regis W. Haid ◽  
Howard H. Kaufman ◽  
Sydney S. Schochet ◽  
Gary D. Marano
Keyword(s):  
Spinal Cord ◽  
Epidural Abscess ◽  
Cord Compression ◽  
Fatty Tissue ◽  
Epidural Lipomatosis ◽  
Neurological Improvement ◽  
Computed Tomographic ◽  
Dose Corticosteroid ◽  
Staphylococcus Aureus Pneumonia ◽  
And Staphylococcus Aureus

Abstract A case of epidural lipomatosis in a 49-year-old man presenting with paraparesis, midthoracic pain, and Staphylococcus aureus pneumonia is reported. The patient had been on low dose corticosteroid therapy for 7 years for rheumatoid arthritis. The clinical and myelographic findings suggested a diagnosis of epidural abscess, but the only abnormality discovered at operation was abundant fatty tissue in the dorsal epidural space significantly compressing the spinal cord, and this was partially removed. Postoperative neurological improvement suggested that the lipomatosis was responsible for the spinal cord compression and dysfunction. If this diagnosis had been suspected, it might have been confirmed by magnetic resonance imaging or postmyelography computed tomographic scanning. With such a diagnosis, an alternative treatment could have been to decrease the steroid dose, observe for clinical improvement, and perhaps avoid operation. (Neurosurgery 21:744-747, 1987)

scholarly journals Rapidly Progressive Spontaneous Spinal Epidural Abscess

2016 ◽  
Vol 2016 ◽  
pp. 1-4
Author(s):  
Abdurrahman Aycan ◽  
Ozgür Yusuf Aktas ◽  
Feyza Karagoz Guzey ◽  
Azmi Tufan ◽  
Cihan Isler ◽  
...  
Keyword(s):  
Epidural Abscess ◽  
Delayed Diagnosis ◽  
Clinical Findings ◽  
Neurological Deficits ◽  
Spinal Epidural Abscess ◽  
Low Back ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Paraspinal Abscess ◽  
Spinal Epidural

Spinal epidural abscess (SEA) is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI) remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

scholarly journals An intrasellar germinoma with normal tumor marker concentrations mimicking primary lymphocytic hypophysitis

2013 ◽  
Vol 57 (7) ◽  
pp. 566-570 ◽  
Author(s):  
Mariana F. Guzzo ◽  
Cristina B. Formiga Bueno ◽  
Thiago T. Amancio ◽  
Sergio Rosemberg ◽  
Cleonice Bueno ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Correct Diagnosis ◽  
Careful Analysis ◽  
Malignant Neoplasms ◽  
Pituitary Hormone ◽  
Appropriate Treatment ◽  
Suprasellar Region ◽  
Neoplastic Lesions ◽  
Posterior Pituitary Hormone ◽  
Pituitary Stalk Thickening

Intracranial germinomas (GE) are malignant neoplasms most commonly found in the suprasellar region, which may cause anterior and particularly posterior pituitary hormone deficits with central diabetes insipidus (DI). Differential diagnosis of pituitary stalk thickening includes granulomatous, inflammatory, infectious, and neoplastic lesions. Although careful analysis of clinical, laboratory, and imaging findings may facilitate the diagnosis, transsphenoidal biopsy is indicated to confirm the disease, as the correct diagnosis directs the appropriate treatment.

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