Spinal epidural abscess: Difference between revisions

Revision as of 13:54, 20 February 2021

Background

Infection of the epidural space, between the dura mater and bone
May be intracranial or spinal, with spinal being far more common
Acquired from contiguous spread (e.g. discitis, otitis media/sinusitis/mastoiditis, direct inoculation (e.g. spinal anaesthesia or neurosurgery), or hematogenous spread
Risk factors include intravenous drug use, hemodialysis, diabetes mellitus, and older age

Microbiology

Staphylococcus aureus is most common cause

Clinical Manifestations

Severe low-back pain often worse with palpation
Fever
Malaise
Neurologic deficits associated with mass effect on spinal cord, interruption of arterial supply, venous thrombosis, or toxin

Staging of Spinal Epidural Abscess

Stage 1: back pain at the level of the affected spine
Stage 2: nerve-root pain radiating from the involved spinal area
Stage 3: motor weakness, sensory deficit, and bladder and bowel dysfunction
Stage 4: paralysis

Diagnosis

Usually made by MRI (or CT with contrast)
Blood cultures may be helpful
Cultures from the abscess fluid, if possible

Management

May need urgent neurosurgical drainage if neurological symptoms
Intravenous antibiotics, ideally after blood cultures are drawn
Typical empiric antibiotics are ceftriaxone and vancomycin

@@ Line 1: / Line 1: @@
-== Background ==
+==Background==
-* Infection of the epidural space, between the dura mater and bone
+*Infection of the epidural space, between the dura mater and bone
-* May be intracranial or spinal, with spinal being far more common
+*May be intracranial or spinal, with spinal being far more common
-* Acquired from contiguous spread (e.g. discitis, otitis media/sinusitis/mastoiditis, direct inoculation (e.g. spinal anaesthesia or neurosurgery), or hematogenous spread
+*Acquired from contiguous spread (e.g. discitis, otitis media/sinusitis/mastoiditis, direct inoculation (e.g. spinal anaesthesia or neurosurgery), or hematogenous spread
-* Risk factors include intravenous drug use, [[hemodialysis]], [[diabetes mellitus]], and older age
+*Risk factors include intravenous drug use, [[hemodialysis]], [[diabetes mellitus]], and older age
-=== Microbiology ===
+===Microbiology===
-* [[Staphylococcus aureus]] is most common cause
+*[[Staphylococcus aureus]] is most common cause
-== Clinical Manifestations ==
+==Clinical Manifestations==
-* Severe low-back pain often worse with palpation
+*Severe low-back pain often worse with palpation
-* Fever
+*Fever
-* Malaise
+*Malaise
-* Neurologic deficits associated with mass effect on spinal cord, interruption of arterial supply, venous thrombosis, or toxin
+*Neurologic deficits associated with mass effect on spinal cord, interruption of arterial supply, venous thrombosis, or toxin
+=== Staging of Spinal Epidural Abscess ===
-== Diagnosis ==
+* Stage 1: back pain at the level of the affected spine
-* Usually made by MRI (or CT with contrast)
+* Stage 2: nerve-root pain radiating from the involved spinal area
-* Blood cultures may be helpful
+* Stage 3: motor weakness, sensory deficit, and bladder and bowel dysfunction
-* Cultures from the abscess fluid, if possible
+* Stage 4: paralysis
-== Management ==
+==Diagnosis==
+*Usually made by MRI (or CT with contrast)
-* May need urgent neurosurgical drainage if neurological symptoms
+*Blood cultures may be helpful
-* Intravenous antibiotics, ideally after blood cultures are drawn
+*Cultures from the abscess fluid, if possible
-* Typical empiric antibiotics are [[Is treated by::ceftriaxone]] and [[Is treated by::vancomycin]]
+==Management==
+*May need urgent neurosurgical drainage if neurological symptoms
+*Intravenous antibiotics, ideally after blood cultures are drawn
+*Typical empiric antibiotics are [[Is treated by::ceftriaxone]] and [[Is treated by::vancomycin]]
 [[Category:Infectious diseases]]