Papilledema as a manifestation of a spinal subdural abscess

Ko, Melissa W.; Osborne, Benjamin; Jung, Sungmi; Jacobs, Dina; Marcotte, Paul J.; Galetta, Steven

doi:10.1016/j.jns.2007.05.013

Cited by 15 publications

(4 citation statements)

References 17 publications

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“…Although this patient has SLE with a known coagulopathy, she did not have venous sinus obstruction. Rather, it would seem that the extremely elevated protein concentration in this patient caused blockage of CSF egress at the level of the arachnoid granulations without a detectable structural abnormality 3 4 5…”

Section: Answersmentioning

confidence: 89%

Papilloedema and vision loss with elevated cerebrospinal fluid protein in a patient with systemic lupus erythematosus: diagnosis and management challenges

Deschler

Miller

Subramanian³

2008

British Journal of Ophthalmology

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Section: Answersmentioning

confidence: 89%

Papilloedema and vision loss with elevated cerebrospinal fluid protein in a patient with systemic lupus erythematosus: diagnosis and management challenges

Deschler

Miller

Subramanian³

2008

British Journal of Ophthalmology

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“…Finally, a large group of patients (12.1% of cases), including the patients presented here, had pre-existing spinal disease. These included symptomatic spinal stenosis [ 48 ], herniated disc [ 23 , 24 ], degenerative disc disease [ 28 ], and ruptured disc [ 17 ]. All of these patients had surgery or injections performed, which was likely the initial source of infection; however, it is also possible that spinal disease itself is a predisposing factor for infection, secondary to chronic inflammatory changes.…”

Section: Discussion and Review Of Literaturementioning

confidence: 99%

Spinal Subdural Abscess Following Laminectomy for Symptomatic Stenosis: A Report of 2 Cases and Review of the Literature

et al. 2016

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Case seriesPatient: Male, 87 • Male, 62Final Diagnosis: Spinal subdural abscessSymptoms: Fever • pain • weaknessMedication: —Clinical Procedure: Laminectomy • durotomy • drainage • debridementSpecialty: NeurosurgeryObjective:Rare diseaseBackground:Spinal subdural abscesses, also known as empyemas, are rare infectious lesions, the exact incidence of which is unknown. Presentation is typically dramatic, with back pain, fever, motor, and sensory deficits. Rapid identification and surgical intervention with laminectomy, durotomy, and washout provides the best outcomes. While hematogenous spread of an extra-spinal infection is the most common cause of this condition, a significant number of cases result from iatrogenic mechanisms, including lumbar punctures, epidural injections, and surgery.Case Report:Here we present 2 cases: 1) an 87-year-old man with type 2 diabetes, schizophrenia, mild cognitive impairment, and symptomatic lumbar spinal stenosis and 2) a 62-year-old man with a prior L3–4 spinal fusion with symptomatic lumbar spinal stenosis. In both cases, patients underwent laminectomy for spinal stenosis and developed epidural abscess. Following successful drainage of the epidural abscess, they continued to be symptomatic, and repeat imaging revealed the presence of a subdural abscess that was subsequently evacuated. Case 1 had significant improvement with residual lower-extremity weakness, while Case 2 made a complete neurological recovery.Conclusions:These cases illustrate patients at increased risk for developing this rare spinal infection, and demonstrate that rapid recognition and surgical treatment is key to cure and recovery. Review of the literature highlights pertinent risk factors and demonstrates nearly one-third of reported cases have an iatrogenic etiology. The cases presented here demonstrate that a subdural process should be suspected in any patient with intractable pain following treatment of an epidural abscess.

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“…The typical clinical presentation includes back pain, fever, and neurologic manifestations such as para/tetra paresis, bladder dysfunction, impaired rectal tone, and disturbances of consciousness. 2,[14][15][16][17] There are three stages of symptom and physical finding progression: stage one, associated with fever and nerve root pain; stage two manifests with mild neurological deficits; stage three represents the full clinical picture of spinal cord compression such as paralysis and complete sensory loss. 15 Clinical presentation of SSA may have a typical progression from stage one to three or be presented at any stage.…”

Section: Discussionmentioning

confidence: 99%

“…Contrast-enhanced MRI is superior in detecting the exact location, extension of the abscess, and in diagnosing spinal cord compression. 11,[15][16][17] Although MRI is the most powerful diagnostic tool, SSA is a surgical diagnosis, because it may be Spinal subdural abscess difficult to correctly differentiate epidural from subdural infection. Based on a literature review, there are two case reports where radiographic findings lagged behind the clinical presentation.…”

Section: Discussionmentioning

confidence: 99%

Spinal Subdural Abscess: A Rare Complication of Decubitus Ulcer

Usoltseva

Medina‐Flores

Rehman

et al. 2014

Clinical Medicine & Research

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A male patient, aged 55 years, presented to the emergency room with complaints of bilateral upper extremity weakness. His past medical history was significant for paraplegia and neurogenic bladder from a spinal cord injury, complicated with decubitus ulcers and end-stage renal disease secondary to type II diabetes mellitus. His past surgical history was significant for posterior spine fusion with Harrington rod instrumentation at the level of T10. He developed subacute onset of bilateral upper extremity weakness and paresthesias on the day of presentation. He reported a 2-day history of neck and back pain that he initially contributed to his bedridden state. The patient denied fever, recent infections, or trauma. His vital signs were unremarkable. Physical examination revealed quadriparesis, absence of deep tendon reflexes, hypoesthesia, and decubitus ulcers (figure 1). He had a normal leukocyte count and elevated C-reactive protein. Blood cultures and cultures from the ulcers were obtained. With the concern of spinal cord compression based on presentation, intravenous corticosteroids and broad spectrum antibiotics were initiated. A magnetic resonance imaging (MRI) scan of the spine (figure 2) revealed large elongated epidural collection posteriorly within the cervical spine, extending into the thoracic spine and inferiorly. Spinal cord compression was prominent in the narrowed areas of disc-osteophyte complexes at the levels of C3-4 and C5-6, where the spinal cord was compressed between these disc-osteophyte complexes and the posterior epidural collection, with some mildly increased signal intensity within the cord. The lumbosacral spine was not well imaged due to artifacts of spinal hardware. Emergent drainage of the collection was indicated, but the patient declined. Per the patient's wishes, palliative care was initiated on the day Spinal subdural abscess (SSA) is an uncommon entity. The exact incidence is unknown, with very few cases reported in the literature. This condition may result in spinal cord compression, thus constituting a medical and neurosurgical emergency. The pathogenesis of SSA is not welldescribed, and the available knowledge is based on case observations only. There is only one case report that describes direct seeding from decubitus ulcers as a possible mechanism for development of SSA. We report a case of subacute onset of quadriplegia in a male patient, age 55 years, due to spinal cord compression from SSA and superimposed spinal subdural hematoma. The direct seeding from decubitus ulcers is thought to be the cause of infection in our patient. We present this case of SSA to elucidate and review the predisposing factors, pathogenesis, clinical presentation, diagnostic modalities, and treatment regarding management of this rare disorder.

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Papilledema as a manifestation of a spinal subdural abscess

Cited by 15 publications

References 17 publications

Papilloedema and vision loss with elevated cerebrospinal fluid protein in a patient with systemic lupus erythematosus: diagnosis and management challenges

Papilloedema and vision loss with elevated cerebrospinal fluid protein in a patient with systemic lupus erythematosus: diagnosis and management challenges

Spinal Subdural Abscess Following Laminectomy for Symptomatic Stenosis: A Report of 2 Cases and Review of the Literature

Spinal Subdural Abscess: A Rare Complication of Decubitus Ulcer

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