Spontaneous spinal epidural abscess in a normoglycemic diabetic patient – Keep it as a differential (original) (raw)
Related papers
Practical Diabetes International, 2006
Epidural abscess is a rare medical emergency that requires a high index of suspicion in order to reach a timely diagnosis. It is more frequent in people with diabetes and, as the prevalence of type 2 diabetes is due to double over the next 20 years, physicians are likely to encounter it more often. We report a case of a man with newly presenting diabetes who attended the Accident & Emergency Department with severe hyperglycaemia and neck and back pain, and who was found to have multiple spinal abscesses. The diagnosis was not confirmed until six days after admission. This case highlights the need for increased awareness of the possibility of this serious condition.
Diabetes mellitus and spinal epidural abscess: clinical or surgical treatment?
Arquivos Brasileiros de Endocrinologia & Metabologia, 2011
Spinal epidural abscess (SEA) is an uncommon condition and its most important predisposing factor is diabetes mellitus. Although the treatment of choice is prompt surgical abscess evacuation, followed by antibiotic therapy, successful conservative treatment of SEA has been reported in some cases. We describe a SEA case in a 23-year old white woman with diabetes for 14 years, who was successfully treated only with antibiotics, and achieved full recovery at the fourth month of follow-up.
Spinal epidural abscess: Report on 27 cases
Surgical Neurology International, 2017
Background: Spinal epidural abscess, although an uncommon disease, often correlates with a high morbidity owing to significant delay in diagnosis. Methods: In a prospective 5-year study, the clinical and magnetic resonance (MR) findings, treatment protocols, microbiology, and neurological outcomes were analyzed for 27 patients with spinal epidural abscess. Results: Patients were typically middle-aged with underlying diabetes and presented with lumbar abscesses. Those undergoing surgical intervention >36 h after the onset of symptoms had poor neurological outcomes. Conclusion: Early recognition and timely evacuation of spinal abscesses minimized neurological morbidity and potential mortality.
Spinal epidural abscess in clinical practice
QJM, 2007
Spinal epidural abscess (SEA) is a rare but severe infection requiring prompt recognition. The major prognostic factor for a favourable outcome is early diagnosis, leading to appropriate treatment. In clinical practice, a diagnosis of SEA is often not considered, particularly in the early stages of the disease when neurological symptoms are not apparent. Knowledge of persons at risk, clinical features and the required diagnostic procedures may decrease the number of initially misdiagnosed cases. Clinical signs, duration of symptoms and the rate of neurological deterioration show a high interindividual variability, and the classic triad (spinal pain, fever and neurological deficit) is often not found, especially not at first presentation to a physician. However, most patients complain of severe localized back pain. Inflammatory parameters in the blood are generally elevated, but not specific. Gadolinium-enhanced magnetic resonance imaging is the most sensitive, specific and accurate imaging method. Although neurosurgical decompression is still the treatment of choice in the majority of cases, less invasive procedures (e.g. computed tomography-guided needle aspiration) or antimicrobial treatment alone can be applied in selected cases. The choice of the most appropriate therapy should be discussed immediately after a confirmed diagnosis in consultation with infectious disease, radiology and spinal surgery specialists. The outcome of SEA is largely influenced by the severity and duration of neurological deficits prior to surgery, stressing the importance of early recognition.
Spinal Epidural Abscess: A Review of Presentation, Management, and Medicolegal Implications
Asian Spine Journal
Spinal epidural abscess (SEA) is a rare condition associated with significant morbidity and mortality. Despite advances in diagnostic medicine, early recognition of SEAs remains elusive. The vague presentation of the disease, coupled with its numerous risk factors, the diagnostic requirement for obtaining advanced imaging, and the necessity of specialized care constitute extraordinary challenges to both diagnosis and treatment of SEA. Once diagnosed, SEAs require urgent or emergent medical and/or surgical management. As SEAs are a relatively rare pathology, high-quality data are limited and there is no consensus on their optimal management. This paper focuses on presenting the treatment modalities that have been successful in the management of SEAs and providing a critical assessment of how specific SEA characteristics may render one infection more amenable to primary surgical or medical interventions. This paper reviews the relevant history, epidemiology, clinical presentation, rad...
European Journal of Internal Medicine, 2009
To describe the incidence and characterize the clinical manifestations, diagnosis and outcome of spontaneous epidural abscess (SEA) not associated with neurosurgical procedures or instrumentation of the spine.Review of cases of SEA over 10 years. Diagnosis was made by imaging-techniques and surgical examination.Fifteen patients were studied. The incidence of SEA was 0.4 cases per 100,000 person-years. Infection gained access to the epidural space haematogenously in 9 patients (60%). SEA was located at the lumbar (7 cases), cervical (4), cranial (2) and thoracic (1) areas. Local pain was the most common manifestation (93.3%); fever was absent in 40%. One third did not show neurologic abnormalities. Staphylococcusaureus was the most commonly isolated agent (87% of cases). All the patients received antimicrobial therapy for a mean period of 6.1 ± 3.9 weeks. In addition, open surgical drainage or CT-guided needle aspiration was successfully performed in 10 and 3 patients respectively. Two patients were managed with antibiotics alone. Poor outcome occurred more frequently in patients with abscess at higher levels (67% in cranial or cervical abscesses versus 0% in thoracic or lumbosacral abscesses). An association was found between delayed diagnosis and poor outcome (p < 0.05). Overall, 54% of our patients recovered without sequelae.SEA resulted from the extension of nearby or distant infections into the epidural space. Diagnosis was frequently delayed and the patient's neurologic status at presentation was the most important predictor of the outcome. The onset of spinal pain in patients with focal infections should prompt MRI of the spine, even in the absence of neurologic abnormalities or fever.
European Spine Journal, 2011
Spinal epidural abscess (SEA) is a rare, but serious, condition with multiple causes. We prospectively studied the aetiology, predisposing factors, and clinical outcomes of SEA in all patients with SEA treated in our hospital's neurosurgical service from 2004 to 2008. For each patient, we recorded the medical history, comorbidities, focus of infection, pathogen(s), and outcome. The 36 patients (19 women and 17 men) ranged in age from 34 to 80 years old (mean 57; median 56). The SEA was primary (i.e., due to haematogenous spread) in 16 patients (44%); it was secondary to elective spinal procedures, either injections or surgery, in 20 patients (56%). The duration of follow-up was 12-60 months (mean 36; median 37.5). The most common pathogen, Staphylococcus aureus, was found in 18 patients (50%). Patients with primary SEA had different underlying diseases and a wider range of pathogens than those with secondary SEA. Only five patients (14%) had no major comorbidity; 16 of the 20 patients with secondary SEA (44% of the overall group) had undergone spinal surgery before developing the SEA; the treatment of the SEA involved multiple surgical operations in all 16 of these patients, and spinal instrumentation in 5 (14%); 22 patients (61% of the overall group) recovered fully.