MR imaging of spinal epidural sepsis

Abstract

are found. Left untreated, the natural course of the disease leads to paraplegia and death [1 -9]. Paraplegia results from compression of the spinal cord or cauda equina by the epidural mass or from thrombophlebitis of the spinal epidural veins resulting in venous infarction of the spinal cord. Death is a result of septicemia. The prognosis for survival and prevention of serious neurologic deficit relates to the rapidity with which appropriate decompression and antibiotic therapy are instituted. The neurologic deficit is less likely to be reversible the more severe and the longer it has been present. Thus, many authors have recognized that prompt and early diagnosis is critical to the management of this potentially curable disease [1-13]. We recently encountered four patients with spinal epidural infections (three pyogenic, one tuberculous) in whom MR imaging of the spine led to expeditious treatment and better clinical outcome. Materials and Methods Four patients with spinal epidural infections (three Staphylococcus aureus, one Mycobacterium tuberculosis)were examined with MR imaging. MR was performed on a GE Signa system with a 1.5-T superconducting CT scans of the spine were obtained on a Siemens DR3 Somatom or Picker 1200 SX unit. Radiographs of the spine were available in all cases.

Thoracic Spinal Epidural Abscess Caused by Salmonella Typhi -Case Report-

“…Our patient had gross neurological deficits, which should raise even more concern for this disease. The MR imaging findings in our case were similar to those reported elsewhere, 2,9) with narrowing of the disk space and enhanced space and epidural mass. We think that routine use of MR imaging in our hospital led to early detection and prevented devastating neurological sequelae in our patient.…”

“…3,4,6,14) Modern noninvasive modalities of investigation such as magnetic resonance (MR) imaging are also leading to increased rates of identification of spinal epidural abscess. 2,9) On the other hand, the combination of vertebral osteomyelitis and epidural abscess is rare, accounting for only 1-4% of all bone infections. 11) Here, we report an unusual case of epidural abscess and vertebral osteomyelitis in the dorsal spine caused by Salmonella typhi.…”

Epidural abscess in a diabetic patient with complicated pyelonephritis: Case report and literature review

“…About 30% of patients did not have identifiable source of infection, 22% enters through soft and skin parts, 22% after invasive procedures and 10% by hematogenous spread due to intravenous drugs (Darouiche et al, 1992). Although 62% of blood cultures gives a positive result, 90% of abscesses material and 19% of the liquor can result in a specific germ (Angtuaco et al, 1987;Reihsaus et al, 2000;Sendi et al, 2008). The most common site of infection is the thoracolumbar region, due to the greater presence of fatty tissue, vascularization and lower adherence of the dura mater to the cord, as observed in this case (L4 to S1) (Grewal et al, 2006;Mampalam et al, 1989;Simpson et al, 1999).…”

“…If the paralysis persists for more than 36 to 48 h, nonsurgical approach is recommended (Mampalam et al, 1989). In cases without acute neurological involvement, diagnostic aspiration followed by antibiotic therapy for 4 to 8 weeks may be a reasonable choice (Angtuaco et al, 1987;Bremer and Darouiche, 2004). Prolonged courses (around 6 weeks) are preferred due the presence of associated vertebral osteomyelitis.…”

Gas-Containing Cervical Epidural Abscess Accompanying Bacterial Meningitis in an Adult

“…To the best of our knowledge, a gas-producing spinal epidural abscess complicating bacterial meningitis has never been reported in an adult. Spinal epidural abscess is a diagnosis that may constitute a neurological emergency, which can result in catastrophic and irreversible neurological damage in the case of a delay in diagnosis1).…”