Epidural abscess after dental extraction

Burgess, B J

doi:10.1136/emj.18.3.231

Cited by 10 publications

(3 citation statements)

References 4 publications

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“…Dental fractures have not been previously reported to increase the risk of spinal epidural abscess formation, but other odontogenic etiologies of spinal epidural abscess have been reported. Dental extractions are a rare cause of cervical discitis and epidural abscess [ 21 - 22 ]. Streptococcus milleri and Corynebacteria , known bacteria to the mouth, as in our case, have been identified as the causative organisms in previous SEAs related to dental sources [ 21 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…Dental extractions are a rare cause of cervical discitis and epidural abscess [ 21 - 22 ]. Streptococcus milleri and Corynebacteria , known bacteria to the mouth, as in our case, have been identified as the causative organisms in previous SEAs related to dental sources [ 21 , 23 ]. Staphylococcus aureus and Pseudomonas aeruginosa have also been found in SEA related to an odontogenic source [ 24 - 25 ].…”

Section: Discussionmentioning

confidence: 99%

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Delayed Presentation of a Cervical Spinal Epidural Abscess of Dental Origin after a Fall in an Elderly Patient

Bodman

Riordan

Chin

2016

Cureus

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Spinal epidural abscesses are an uncommon cause of spinal cord injury but, depending on the size and presence of neurological deficits, urgent neurosurgical intervention may be required. We present a unique case of a patient presenting with a spinal epidural collection several days after a fall. While a spinal epidural hematoma was suspected based on the patient’s history and MRI findings, a spinal epidural abscess was found during surgery. The patient underwent laminectomy and instrumented fusion with successful treatment of her infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Delayed Presentation of a Cervical Spinal Epidural Abscess of Dental Origin after a Fall in an Elderly Patient

Bodman

Riordan

Chin

2016

Cureus

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“…ESR < 50 25 20 While prior dental work may raise concern for bacteremia with potentially seeding into the epidural space, the literature consists of case reports, which does not allow for the calculation of likelihood ratios [17,18].…”

Section: Sea (N=118)mentioning

confidence: 99%

Using Probability Estimates to Evaluate a Patient With Weakness

Guzner¹,

Goese²,

Yuen³

2022

Cureus

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In this case report, we review how probabilistic reasoning can be implemented in retrospect to refine the diagnostic process. A 67-year-old female with a history of polymyalgia rheumatica (PMR) and a recent dental procedure presented with weakness, falls, and chills ongoing for two weeks. She reported pain in her shoulders and lower back. On presentation, she was febrile, and labs were notable for leukocytosis with neutrophilic predominance and an elevated erythrocyte sedimentation rate (ESR). Chest radiograph revealed a left lower lung opacity, which was not seen on a repeat film. She was treated with antibiotics for community-acquired pneumonia and steroids for an exacerbation of PMR. After eight days of hospitalization, she was transferred to a subacute rehabilitation facility. A month later, she was readmitted with worsening lower back pain and right lower extremity weakness. Imaging revealed discitis and osteomyelitis at L1-L2. A spinal epidural abscess was present, leading to severe compression of the cauda equina nerve roots. Aspirate was positive for group B streptococcus. With antibiotic treatment alone, she recovered with resolution of her weakness.In reviewing the literature, it becomes evident where improvements could have been made in the diagnostic process. Fever, leukocytosis, and neurological weakness are not commonly associated with PMR exacerbations. Lack of cough or shortness of breath, a persistently elevated erythrocyte sedimentation rate and C-reactive protein despite antibiotic treatment, and a repeat chest radiograph without an opacity suggest an alternative diagnosis to pneumonia. Persistent back pain with an insidious onset is a feature of untreated spinal epidural abscess. Steroid use and dental procedures are possible risk factors for spinal epidural abscess. By shedding light on how probabilities should be estimated, we hope to encourage probabilistic thinking to improve diagnostic accuracy. As with the best political forecasters, making precise probability estimates and frequently updating them may improve diagnostic accuracy for clinicians.

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Pyogenic infections of the central nervous system secondary to dental affections—a report of six cases

2006

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Pyogenic infections of the central nervous system of dental origin are quite uncommon in industrialized countries. We report six cases with intracerebral (n = 4) and intraspinal (n = 2) infections treated in our hospital. The microbial pathogen was successfully isolated in all patients. Fusobacterium nucleatum as well as Streptococcus species were found in three cases. Bacillus species were identified in two patients. Actinomyces was the etiologic agent in one case. All patients suffered from dental pathologies, so that after clinical and radiological exclusion of other sources an oral focus was presumed. Therapeutic management consisted of an operative procedure in order to obtain decompression, as well as evacuation of the pus on the one hand, followed by targeted antibiotics on the other. Clinical improvement was achieved in all patients, with one patient lost to follow-up. On magnetic resonance tomography, the inflammatory changes also disappeared in all cases. We recommend that oral infection with recurrent bacteraemia should always be considered in the pathogenesis of the so-called "cryptic" intracerebral and intraspinal infections.

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Epidural abscess after dental extraction

Cited by 10 publications

References 4 publications

Delayed Presentation of a Cervical Spinal Epidural Abscess of Dental Origin after a Fall in an Elderly Patient

Delayed Presentation of a Cervical Spinal Epidural Abscess of Dental Origin after a Fall in an Elderly Patient

Using Probability Estimates to Evaluate a Patient With Weakness

Pyogenic infections of the central nervous system secondary to dental affections—a report of six cases

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