scholarly journals Spinal Epidural Abscess in a Child with Eczema: A Case Report and Literature Review

2012 ◽  
Vol 19 (6) ◽  
pp. 411-416 ◽  
Author(s):  
YP Tsang ◽  
MY Sy ◽  
TW Wong
Keyword(s):  
Computed Tomography ◽  
Epidural Abscess ◽  
Early Recognition ◽  
Emergency Operation ◽  
Neurological Complications ◽  
Uneventful Recovery ◽  
Spinal Epidural Abscess ◽  
History Of ◽  
Spinal Epidural ◽  
Chronic Eczema

Spinal epidural abscess is rare in children. Early recognition is important to prevent or minimise neurological complications. We report a case of paediatric spinal epidural abscess. An 8-year-old girl, with a history of poorly controlled atopic eczema over the back of neck, presented with back pain and subsequently fever and worsening backache. Diagnosis was made only after computed tomography. Emergency operation with drainage of the abscess was done and vancomycin was given for 5 weeks. The patient made an uneventful recovery with no neurological complications. Bacteraemia from skin excoriation due to chronic eczema was the presumed aetiology.

scholarly journals Community-Acquired MRSA Pyomyositis: Case Report and Review of the Literature

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Douglas P. Olson ◽  
Sarita Soares ◽  
Sandhya V. Kanade
Keyword(s):  
Epidural Abscess ◽  
Surgical Intervention ◽  
Cauda Equina ◽  
Spinal Epidural Abscess ◽  
Paraspinal Muscles ◽  
Sensory Deficits ◽  
Antibiotic Management ◽  
History Of ◽  
Spinal Epidural ◽  
Repeat Imaging

Community-acquired methicillin-resistantStaphylococcus aureus(CA-MRSA) is responsible for a broad range of infections. We report the case of a 46-year-old gentleman with a history of untreated, uncomplicated Hepatitis C who presented with a 2-month history of back pain and was found to have abscesses in his psoas and right paraspinal muscles with subsequent lumbar spine osteomyelitis. Despite drainage and appropriate antibiotic management the patient's clinical condition deteriorated and he developed new upper extremity weakness and sensory deficits on physical exam. Repeat imaging showed new, severe compression of the spinal cord and cauda equina from C1 to the sacrum by a spinal epidural abscess. After surgical intervention and continued medical therapy, the patient recovered completely. This case illustrates a case of CA-MRSA pyomyositis that progressed to lumbar osteomyelitis and a spinal epidural abscess extending the entire length of the spinal canal.

scholarly journals Just the Facts: Risk stratifying non-traumatic back pain for spinal epidural abscess in the emergency department

CJEM ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 753-755
Author(s):  
Zoe Polsky ◽  
Shawn K. Dowling ◽  
W. Bradley Jacobs
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Epidural Abscess ◽  
Spinal Epidural Abscess ◽  
Thoracic Spinal ◽  
Life Threatening ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Whole Spine ◽  
Spinal Epidural

A 65-year-old male with a history of hypertension presents to the emergency department (ED) with new onset of non-traumatic back pain. The patient is investigated for life-threatening diagnoses and screened for “red flag symptoms,” including fever, neurologic abnormalities, bowel/bladder symptoms, and a history of injectiondrug use (IVDU). The patient is treated symptomatically and discharged home but represents to the ED three additional times, each time with new and progressive symptoms. At the time of admission, he is unable to ambulate, has perineal anesthesia, and 500 cc of urinary retention. Whole spine magnetic resonance imaging (MRI) confirms a thoracic spinal epidural abscess. This case, and many like it, prompts the questions: when should emergency physicians consider the diagnosis of a spinal epidural abscess, and what is the appropriate evaluation of these patients in the ED? (Figure 1).

scholarly journals A Predictive Clinical Model to Facilitate Early Recognition of Spinal Epidural Abscess in Adults

2016 ◽  
Vol 3 (suppl_1) ◽  
Author(s):  
Andrew Artenstein ◽  
Jennifer Friderici ◽  
Adam Holers ◽  
Deirdre Lewis ◽  
Jan Fitzgerald ◽  
...  
Keyword(s):  
Epidural Abscess ◽  
Early Recognition ◽  
Spinal Epidural Abscess ◽  
Clinical Model ◽  
Spinal Epidural

scholarly journals Tubercular spinal epidural abscess involving the dorsal-lumbar-sacral region without osseous involvement

2011 ◽  
Vol 5 (07) ◽  
pp. 544-549 ◽  
Author(s):  
Sumit Arora ◽  
Ramesh Kumar
Keyword(s):  
English Language ◽  
Medical Literature ◽  
Epidural Abscess ◽  
Cauda Equina ◽  
Uneventful Recovery ◽  
Spinal Epidural Abscess ◽  
Vertebral Level ◽  
Osseous Involvement ◽  
Vertebral Involvement ◽  
Spinal Epidural

Musculoskeletal tuberculosis is known for its ability to present in various forms and guises at different sites. Tubercular spinal epidural abscess (SEA) is an uncommon infectious entity. Its presence without associated osseous involvement may be considered an extremely rare scenario. We present a rare case of tubercular SEA in an immune-competent 35-year-old male patient. The patient presented with acute cauda equina syndrome and was shown to have multisegmental SEA extending from D5 to S2 vertebral level without any evidence of vertebral involvement on MRI. The patient made an uneventful recovery following surgical decompression and antitubercular chemotherapy. The diagnosis was confirmed by histopathological demonstration of Mycobacterium tuberculosis in drained pus. Such presentation of tubercular SEA has not been reported previously in the English language based medical literature to the best of our knowledge

scholarly journals An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions

2014 ◽  
Vol 37 (2) ◽  
pp. E9 ◽  
Author(s):  
Faris Shweikeh ◽  
Kashif Saeed ◽  
Laura Bukavina ◽  
Stephanie Zyck ◽  
Doniel Drazin ◽  
...  
Keyword(s):  
Literature Search ◽  
Epidural Abscess ◽  
Early Recognition ◽  
Thoracolumbar Spine ◽  
Signs And Symptoms ◽  
Neurological Deficits ◽  
Current Status ◽  
Spinal Epidural Abscess ◽  
Presenting Symptoms ◽  
Spinal Epidural

Object Over the past decade, the incidence of bacterial spinal epidural abscess (SEA) has been increasing. In recent years, studies on this condition have been rampant in the literature. The authors present an 11-year institutional experience with SEA patients. Additionally, through an analysis of the contemporary literature, they provide an update on the challenging and controversial nature of this increasingly encountered condition. Methods An electronic medical record database was used to retrospectively analyze patients admitted with SEA from January 2001 through February 2012. Presenting symptoms, concurrent conditions, microorganisms, diagnostic modalities, treatments, and outcomes were examined. For the literature search, PubMed was used as the search engine. Studies published from January 1, 2000, through December 31, 2013, were critically reviewed. Data from articles on methodology, demographics, treatments, and outcomes were recorded. Results A total of 106 patients with bacterial SEA were identified. The mean ± SD age of patients was 63.3 ± 13.7 years, and 65.1% of patients were male. Common presenting signs and symptoms were back pain (47.1%) and focal neurological deficits (47.1%). Over 75% of SEAs were in the thoracolumbar spine, and over 50% were ventral. Approximately 34% had an infectious origin. Concurrent conditions included diabetes mellitus (35.8%), vascular conditions (31.3%), and renal insufficiency/dialysis (30.2%). The most commonly isolated organism was Staphylococcus aureus (70.7%), followed by Streptococcus spp. (6.6%). Surgery along with antibiotics was the treatment for 63 (59.4%) patients. Surgery involved spinal fusion for 19 (30.2%), discectomy for 14 (22.2%), and corpectomy for 9 (14.3%). Outcomes were reported objectively; at a mean ± SD follow-up time of 8.4 ± 26 weeks (range 0–192 weeks), outcome was good for 60.7% of patients and poor for 39.3%. The literature search yielded 40 articles, and the authors discuss the result of these studies. Conclusions Bacterial SEA is an ominous condition that calls for early recognition. Neurological status at the time of presentation is a key factor in decision making and patient outcome. In recent years, surgical treatment has been advocated for patients with neurological deficits and failed response to medical therapy. Surgery should be performed immediately and before 36–72 hours from onset of neurological sequelae. However, the decision between medical or surgical intervention entails individual patient considerations including age, concurrent conditions, and objective findings. An evidence-based algorithm for diagnosis and treatment is suggested.

scholarly journals 1414. Time-to-Completed-Imaging, Survival, and Function in Patients with Spinal Epidural Abscess: Description of a Series of 34 Patients, 2015–2018

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S515-S515 ◽  
Author(s):  
Caroline King ◽  
Cameron Fisher ◽  
Patrick Brown ◽  
Kelsey Priest ◽  
Mary Tanski ◽  
...  
Keyword(s):  
Drug Use ◽  
Epidural Abscess ◽  
Intravenous Drug ◽  
Future Research ◽  
Prior History ◽  
Spinal Epidural Abscess ◽  
Intravenous Drug Use ◽  
History Of ◽  
Spinal Epidural ◽  
Mean Time

Abstract Background Spinal epidural abscess (SEA) is a rare and life-threatening infection with increased incidence over the past two decades. Delays in diagnosis cause significant morbidity and mortality among patients. The objective of this study was to describe average time-to-imaging and frequencies of intervention, risk factors, and outcomes among patients with SEA presenting to an emergency department at a single academic health center in Portland, Oregon. Methods This retrospective cohort study reviewed data from patients with no prior history of SEAs at a single hospital from October 1, 2015 to April 1, 2018. We report measures of central tendency and frequencies of collected information. Results Of the 34 patients included, seven (20%) died or were discharged with plegia during the study period. Four others (11.8%) had motor weakness, and four (11.8%) patients had new bowel or bladder dysfunction at discharge. Those who died or were discharged with plegia (n = 7) had shorter mean time-to-imaging order (20.8 hours vs. 29.2 hours). Patients with a history of intravenous drug use had a longer mean time-to-imaging order (30.2 hours vs. 23.7 hours) vs. those without a history of intravenous drug use. Furthermore, only three (42.9%) of the seven patients who died or acquired plegia presented with the three symptom classic triad of SEA: (1) fever; (2) abnormal neurologic examination or symptoms; and (3) neck or back pain. Conclusion SEA is a potentially deadly infection requiring prompt identification and treatment. This research provides baseline data for potential quality improvement work at the study site. Future research should evaluate multi-center approaches for identifying and intervening to treat SEA, particularly among patients with a history of intravenous drug use. Disclosures All authors: No reported disclosures.

scholarly journals Spinal Epidural Abscess in Adults: A 10-Year Clinical Experience at a Tertiary Care Academic Medical Center

2016 ◽  
Vol 3 (4) ◽  
Author(s):  
Andrew W. Artenstein ◽  
Jennifer Friderici ◽  
Adam Holers ◽  
Deirdre Lewis ◽  
Jan Fitzgerald ◽  
...  
Keyword(s):  
Epidural Abscess ◽  
Early Recognition ◽  
Linear Trend ◽  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Critical Threshold ◽  
Spinal Epidural Abscess ◽  
Academic Medical ◽  
Spinal Epidural

Abstract Background.  Delayed recognition of spinal epidural abscess (SEA) contributes to poor outcomes from this highly morbid and potentially lethal infection. We performed a case-control study in a regional, high-volume, tertiary care, academic medical center over the years 2005–2015 to assess the potential changing epidemiology, clinical and laboratory manifestations, and course of this disorder and to identify factors that might lead to early identification of SEA. Methods.  Diagnostic billing codes consistent with SEA were used to identify inpatient admissions for abstraction. Subjects were categorized as cases or controls based on the results of spinal imaging studies. Characteristics were compared using Fisher's exact or Kruskal-Wallis tests. All P values were 2-sided with a critical threshold of <.05. Results.  We identified 162 cases and 88 controls during the study period. The incidence of SEA increased from 2.5 to 8.0 per 10 000 admissions, a 3.3-fold change from 2005 to 2015 (P < .001 for the linear trend). Compared with controls, cases were significantly more likely to have experienced at least 1 previous healthcare visit or received antimicrobials within 30 days of admission; to have comorbidities of injection drug use, alcohol abuse, or obesity; and to manifest fever or rigors. Cases were also more likely to harbor coinfection at a noncontiguous site. When available, inflammatory markers were noted to be markedly elevated in cases. Focal neurologic deficits were seen with similar frequencies in both groups. Conclusions.  Based on our analysis, it appears that selected factors noted at the time of clinical presentation may facilitate early recognition of SEA.

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