Enterococcus avium cerebellar abscess (original) (raw)

Spinal Epidural Abscess: Diagnosis and Treatment

Operative Techniques in Neurosurgery, 2004

Spinal epidural abscess (SEA) is an uncommon entity, with an incidence of 0.2 to 2 per 10,000 hospital admissions. It is associated with potentially devastating neurological consequences. The incidence is increasing with the increase in intravenous drug use and increasing spinal procedures. SEA is classically described as presenting with fever, focal back pain, and progressive neurological symptoms. However, patients rarely fulfill all the characteristics of this pathognomonic triad. The key in diagnosis is a high level of suspicion when patients present with back pain. MRI is highly accurate in the evaluation. Empiric antibiotics for SEA must include coverage for staphylococci (vancomycin pending organism identification and susceptibility testing) and gram-negative bacilli (e.g., ceftazidime, cefepime, or meropenem), and antibiotics should continue for at least 8 weeks. Surgical evacuation remains the standard treatment in patients who present with neurologic signs on physical examination or who have failed medical management. The prognosis depends on the presenting neurologic status. Despite recent efforts, SEA is associated with a high mortality rate, most likely a result of delayed diagnosis and poor neurologic status at presentation. Therefore, high suspicion and early diagnosis remain the most important factors in the management of SEA. Oper Tech Neurosurg 7: [188][189][190][191][192]

Recent Developments in the Treatment of Spinal Epidural Abscesses

Orthopedic reviews, 2017

Spinal epidural abscess (SEA) is a serious condition that can be challenging to diagnose due to nonspecific symptomology and delayed presentation. Despite this, it requires prompt recognition and management in order to prevent permanent neurologic sequelae. Several recent studies have improved our understanding of SEA. Herein, we summarize the recent literature from the past 10 years relevant to SEA diagnosis, management and outcome. While surgical care remains the mainstay of treatment, a select subset of SEA patients may be managed without operative intervention. Multidisciplinary management involves internal medicine, infectious disease, critical care, and spine surgeons in order to optimize care.

Spinal epidural abscess: clinical presentation, management, and outcome

Surgical Neurology, 2005

We sought to describe the clinical characteristics of patients with spinal epidural abscess and to relate presentation and treatment to short-term clinical and neurologic outcome. We retrospectively reviewed the records and radiographic images of all patients admitted to our institution with a diagnosis of spinal epidural abscess between January 1995 and March 2001. Thirty males and 18 females were admitted with spinal epidural abscess. Median age was 61 years (range, 31-84). Twenty-three of 48 patients were febrile at presentation and the mean white blood cell (WBC) count was 15.5 (range, 4.0-38.7). Twenty-seven patients presented with motor deficits, 17 with pain alone, 2 with sepsis, 1 with dysphagia, and 1 incidentally on spinal imaging. Intravenous drug abuse was the most common risk factor (13 patients) followed by the presence of nonspinal infection, including endocarditis (10 patients). Blood cultures were positive in 29 patients. Staphylococcus aureus was the most common organism cultured from abscesses. Collections were located in the cervical spine in 11 patients, cervicothoracic in 4, thoracic in 7, thoracolumbar in 4, and lumbosacral in 22. One patient harbored both cervical and lumbar epidural abscesses. Twenty-three patients initially received nonoperative therapy with antibiotics alone; 25 underwent urgent surgery. Eleven patients initially treated with antibiotics eventually deteriorated and required delayed surgery. Patients receiving antibiotics suffered a significantly greater number of unfavorable outcomes (clinical deterioration or death) than those in the early surgical group (P < 0.005). Patients with spinal epidural abscess may be normothermic and have normal WBC counts. Urgent surgery was more likely to be offered to patients presenting with neurologic deficits than with pain alone. Patients treated without early surgery were significantly more likely to deteriorate and suffer poor outcomes.

Insidious Onset of Tetraparesis due to Cervical Epidural Abscess from Enterococcus faecalis

Case Reports in Medicine, 2013

We report a case of cervical epidural abscess from Enterococcus faecalis, which caused an insidious onset of tetraparesis. This 53year-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.

Group A Streptococcus Spinal Epidural Abscess During Varicella

PEDIATRICS, 2002

Multiple complications of varicella have been described. Musculoskeletal complications (osteomyelitis, septic arthritis, and necrotizing fasciitis) as well as neurologic complications (ataxia, encephalitis, and transverse myelitis) are well-known. We describe the cases of 2 children, ages 18 months and 5 years, who were admitted recently to 2 pediatric hospitals in Montreal with a resolving varicella, abdominal and lumbar pain, and a refusal to walk and in whom a diagnosis of epidural abscess caused by group A streptococcus (GAS) was established. No previous case of epidural abscess caused by GAS in the context of varicella has been reported. Epidural abscesses are rare in pediatrics and are caused mainly by hematogenous spread of Staphylococcus aureus. The diagnosis in pediatrics is challenging because it is rare and does not present as classically as in adults. The prognosis is related to the presence of neurologic deficits before surgery and to the rapidity with which the diagnosis and the intervention are made. These cases highlight a new clinical association in children of epidural abscess caused by GAS and varicella. An early clinical diagnosis requires a high index of suspicion when back or abdominal pain with or without neurologic signs and symptoms occurs during or soon after varicella. Pediatrics 2002;109(1). URL: http://www. pediatrics.org/cgi/content/full/109/1/e14; varicella, spinal epidural abscess, group A streptococcus.

Extensive spinal epidural abscess complicated with hydrocephalus

Romanian Neurosurgery, 2015

Spinal epidural abscess is a rare but severe infection requiring prompt recognition in order to have a favorable outcome and appropriate treatment, mainly surgical. We present one of the largest extensions of such abscess in literature, involving the whole spine. No surgical treatment was tempted due to the involvement of 19 levels but antibiotics. The evolution of the lesion was complicated with hydrocephalus, by mechanism of cervical block of CSF flow, and needed first external derivation and later ventriculo-peritoneal drainage.