China
Africa
Explore chapters and articles related to this topic
Epidural and Intrathecal Analgesia
Published in Pamela E. Macintyre, Stephan A. Schug, Acute Pain Management, 2021
Pamela E. Macintyre, Stephan A. Schug
The signs and symptoms of an epidural abscess may be similar to those of an epidural hematoma, except that onset is often later and commonly much slower. Presentation of an epidural abscess may be delayed until days or even weeks after the patient has been discharged from hospital. The most frequent presenting symptoms of a thoracic epidural abscess are neurological deficits (68%) (paraparesis 48% and paraplegia 20%), back pain (64%), fever (24%), and loss of bowel or bladder control (16%) (Howie et al, 2018). Note that the patient may not be febrile. Patients with severe increasing back pain after epidural catheter placement should be investigated promptly, even in the absence of a fever (Schug et al, 2020).
Neurology
Published in Faye Hill, Sash Noor, Neel Sharma, Tiago Villanueva, Medical and Surgical Emergencies for Students and Junior Doctors, 2021
Faye Hill, Sash Noor, Neel Sharma
First-line treatment involves immobilisation and urgent neurosurgical intervention. High-dose steroids have been shown to be of benefit, particularly in cases of malignancy, to help with pain relief and reduction of tumour-associated oedema. In cases of an epidural abscess, surgery in addition to antibiotic therapy, usually in the form of vancomycin, metronidazole and cefotaxime, is required.
Revision of failed posterior cervical fusions
Published in Gregory D. Schroeder, Ali A. Baaj, Alexander R. Vaccaro, Revision Spine Surgery, 2019
Trevor Mordhorst, Vadim Goz, William Ryan Spiker
Patients presenting with continued symptoms of radiculopathy or myelopathy that are unchanged compared to preoperative symptoms should be evaluated for potential continued central or foraminal stenosis at the operative level. Another potential etiology of continued symptoms that should be investigated in this setting is whether a symptomatic level may have remained unaddressed during the index procedure. Another important etiology to consider during the acute postoperative period is infection. Infection can present at any time after the index surgery, although the acute and subacute postoperative periods are the highest risk. Pain can be associated with systemic signs/symptoms of fevers/chills/poor appetite and malaise. Epidural abscess formation can result in progressive neurologic deficits and is a surgical emergency that must be monitored for carefully.
Spinal brucellosis with large circumscribed paraspinal and epidural abscess formation: a case report
Published in British Journal of Neurosurgery, 2021
Majid Reza Farrokhi, Seyed Reza Mousavi
Spinal epidural abscess caused by brucellosis is a well described condition, which generally represents an acute infection of the thoracolumbar region.12 Spondylitis, spondylodiscitis, epidural abscess, paraspinal abscess, discitis and vertebral collapse can be seen as clinical manifestations in spinal brucellosis.13 A few case reports and retrospective studies have been published reporting epidural abscesses mainly in the lumbar and thoracic regions,14 but large paraspinal and epidural abscess is quite rare. According to spinal brucellosis studies, although brucellosis lesions may arise in the spine at any level, the lumbar spine especially the L4 and L5 vertebrae, has the most involvement.15 In our case, osteomyelitis of L4, L5 and sacrum, accompanying intervertebral disc spondylodiscitis and enhancing abscess formation in the epidural area were detected at MRI and CT.
Actinomyces odontolyticus causing meningitis and cervical abscess
Published in Baylor University Medical Center Proceedings, 2021
Hanish Jain, Garima Singh, Ambika Eranki
A 73-year-old man with a history of oropharyngeal squamous cell carcinoma of the tongue (human papillomavirus–positive) having completed chemotherapy presented with neck pain for 10 days and confusion for 2 days. The pain started gradually and had become progressively worse, radiating to the shoulders. He had a temperature of 102°F. On physical exam, he was drowsy and had neck stiffness. Laboratory values were significant for a white blood cell count of 22.7 × 103/μL, predominantly neutrophilic. A lumbar puncture was performed and analysis revealed cerebrospinal fluid protein of 199 mg/dL; glucose, 3 mg/dL; white blood cell count, 6650/mm3; red blood cell count, 158/mm3; and segmented neutrophils, 96%. A gram stain revealed gram-positive cocci in pairs and short chains. He was started on vancomycin, ceftriaxone, and ampicillin empirically. The cerebrospinal fluid culture was negative for aerobic organisms. Computed tomography of the neck with contrast showed gas in the upper cervical spinal canal with a heterogeneous mass on the right side of the tongue. Magnetic resonance imaging of the cervical spine showed a C2-C3 epidural abscess anteriorly consistent with a 3.4 × 1.4 × 0.8 cm epidural abscess with cord compression. Treatment was switched to vancomycin, cefepime, and metronidazole.
Surgery is safe and effective when indicated in the acute phase of hematogenous pyogenic vertebral osteomyelitis
Published in Infectious Diseases, 2019
Etienne Canouï, Virginie Zarrouk, Florence Canouï-Poitrine, Ugo Desmoulin, Véronique Leflon, Wassim Allaham, Victoire de Lastours, Pierre Guigui, Bruno Fantin
At baseline, the presences of a neurological deficit, as well as three imaging findings (bone destruction, epidural abscess, and spinal compression), were independently associated with surgery. These results, in agreement with previous studies, emphasize the need for clinical and radiological evaluation to determine the best treatment strategy [2,6,8]. Interestingly, an epidural involvement on imaging, without abscess formation, was not associated per se with surgical treatment. Indeed, seven patients with epidural involvement and a neurological deficit were treated only medically and six had a favorable neurological outcome. These results suggest that epidural involvement per se, without spinal cord compression, may be treated without surgery. Others have also suggested that surgery should only be recommended in cases with epidural abscess associated with a neurological deficit [14,15].