Spinal epidural abscess: contemporary trends in etiology, evaluation, and management

Cervical Epidural Abscess Presenting with Brown-Sequard Syndrome in a Patient with Type 2 Diabetes

“…Classical symptoms of spinal epidural abscess include back pain, fever, and neurological deficits (7,8,14). Of these, the most frequent symptom is back pain (7,8,15). However, this triad is only present in 10-15% of cases at the first consultation.…”

Abcesso epidural pós-traumático

“…Trauma and immunodepression (in this case, secondary to prolonged AS treatment) are factors predisposing the development of epidural abscess (3,4,6) . Its association to closed trauma is seen in up to 15% of the cases (10) , but a primary infection source usually exists and can be identified. Trauma is believed to cause an epidural hematoma, and this gets infected.…”

“…However, few reports in literature prove this theory, with REFERENCES whenever possible, the association of metal implants in cases of epidural abscess should be avoided. an alternative described in literature is to drain abscesses through an epidural catheter followed by local irrigation, but usually electively and in patients without neurological deficit (10,13) . In patients with no neurological symptom and with good health status, antibiotics can be recommended as a single therapy, with no surgical decompression, since a careful clinical follow-up is provided and the surgical alternative is performed in cases of signs of sepsis or neurological symptoms.…”

“…Epidural abscess may present as a non-specific form, with variable complaints of pain, palsies and constitutional symptoms, followed by sudden and fulminant worsening (8) . The most common symptom is pain (in 90% of the cases), followed by fever (60 -70% of the cases) (10) . Muscular spasm, motion restraint, and difficult ambulation may be present, but neurological symptoms are present in less than 30% of the patients at diagnosis.…”

“…The presence of a progressive neurological picture associated to history of trauma, made us suspect of epidural hematoma, which may also be associated to spine fractures in AS. The requested NMR scan could identify the epidural mass, but was unable to distinguish hematoma from abscess (8,10) (Figure 1). Concerning site, thoracic spine seems to be associated to a worse prognosis of neurological recovery, even after surgical decompression procedure, when compared to cervical and lumbar spine (2,3,6,12) .…”