ABSTRACT
Spinal epidural abscess, if especially caused by Brucellosis is a very rare disease which is usually a consequence of spondylodiscitis. The spinal column can be affected at any joint; however, the lumbar spine is the most common region, especially at the level of the L4-5 and L5-S1. The frequency of spinal involvement usually seen at the lumbar, thoracic and cervical spine respectively. As an occupational disease in farmers, veterinaries, butchers, laboratory staff and shepherds, brucellosis can also occur by direct contact to animals and infected materials or ingestion of raw cheese, milk or unpasteurized milk products. In this study, we presented two cases with cervical spinal epidural abscess caused by brucella melitensis, which was successfully treated by surgical approach. Initial treatment was combined with antibiotic therapy after the surgery for 3 months.
Subject(s)
Animals , Brucella , Brucella melitensis , Brucellosis , Cheese , Discitis , Eating , Epidural Abscess , Milk , Occupational Diseases , Rare Diseases , Spinal Cord Compression , SpineABSTRACT
Cervical epidural abscess (CEA) is a very uncommon disease with diverse clinical presentations. Clinically, it is difficult to diagnose this disease, especially in early stage. We report an atypical case of CEA showing only progressive quadriparesis without any other symptoms or signs of CEA. From this experience, CEA must be considered when progressive quadriparesis without any specific cause is developed in immuno-compromised patients and diabetic patients with polyneuropathies.
Subject(s)
Humans , Diabetes Mellitus , Epidural Abscess , Polyneuropathies , QuadriplegiaABSTRACT
We present a very rare case of spontaneous cervical spondylodiscitis and epidural abscess caused by Klebsiella pneumonia. A 45-year-old man presented with severe posterior neck pain radiating down both arms with decreased range of motion of the neck. He also complained of paresthesia of the upper extremities and a subjective weakness of his right arm. Magnetic resonance imaging (MRI) revealed spondylodiscitis and epidural abscess on the C5 and C6. In order to obtain adequate drainage of the abscess and complete removal of granulation tissues we performed a total decompressive corpectomy of C5 and C6. After drainage of the abscess, single stage autologous iliac bone graft was performed. The patient was followed by three months with antibiotic treatment confirmed to be sensitive to the organism. Klebsiella pneumonia was cultured postoperatively from the surgical biopsy samples. The patient recovered with no complications and the postoperative MRI showed improvement of the lesions.
Subject(s)
Humans , Middle Aged , Abscess , Arm , Biopsy , Decompression , Discitis , Drainage , Epidural Abscess , Granulation Tissue , Klebsiella , Magnetic Resonance Imaging , Neck , Neck Pain , Paresthesia , Pneumonia , Range of Motion, Articular , Transplants , Upper ExtremityABSTRACT
Cervical epidural abscess (CEA) is a very uncommon disease with diverse clinical presentations. Clinically, it is difficult to diagnose this disease, especially in early stage. We report an atypical case of CEA showing only progressive quadriparesis without any other symptoms or signs of CEA. From this experience, CEA must be considered when progressive quadriparesis without any specific cause is developed in immuno-compromised patients and diabetic patients with polyneuropathies.
Subject(s)
Humans , Diabetes Mellitus , Epidural Abscess , Polyneuropathies , QuadriplegiaABSTRACT
Intramedullary myelitis due to bacterial meningitis associated with cervical epidural abscess is very rare. Its cause and clinical features are non-specific, therefore exact diagnosis is often missed or mistaken for other disease and immediate treatment may be delayed. We report a case of intramedullary myelitis due to epidural abscess presented with prominent symptoms of meningitis and manifestations of acute cerebrovacular accident. A 69 -year-old man was admitted due to right hemicranial headache with pain on right posterior neck and febrile sensation. At first, the patient's headache was improved by conservative therapy. Three weeks later, the patient showed abrupt right hemiparesis (MRC grade 2/5) with drowsy mentality. The CSF findings of the patient were compatible with acute bacterial meningitis. Cervical spine MRI showed cervical epidural abscess and extensive intramedullary myelitis from cervical to lumbar spinal cord. After antibiotic therapy, mentality of the patient became to be alert and right hemiparesis was improved to MRC grade 4/5. Follow up cervical spine MRI after several weeks represented that the lesions of cervical epidural abscess and intramedullary myelitis were significantly diminished.
Subject(s)
Humans , Diagnosis , Epidural Abscess , Follow-Up Studies , Headache , Magnetic Resonance Imaging , Meningitis , Meningitis, Bacterial , Myelitis , Neck , Paresis , Sensation , Spinal Cord , SpineABSTRACT
The pseudomonas spinal epidural abscess is a extremely rare disease. It is well known that early diagnosis and surgical evacuations of the lesions are very important for better treatment results. Two cases of cervical epidural abscess were admitted to our hospital with neck pain, chillness and quadriparesis. One month prior to admission, the two patients underwent stellate ganglion block at an same institution on the same day, to releive the pain in the neck and the scapular area. Antibiotic therapy was initiated immediately and surgical decompression was performed through a posterior approach. Total laminectomy of C4-C7 was done and greenish pus and granulation tissue from anterior epidural space were evacuated. Culture of the pus revealed pseudomonas aeruginosa. In both of these cases, stellate ganglion block was suspected causes of infection. First patient patient recovered completely, but second had severe neurological deficit with quadriparesis.
Subject(s)
Humans , Decompression, Surgical , Early Diagnosis , Epidural Abscess , Epidural Space , Granulation Tissue , Laminectomy , Neck , Neck Pain , Pseudomonas aeruginosa , Pseudomonas , Quadriplegia , Rare Diseases , Stellate Ganglion , SuppurationABSTRACT
The transoral approach to anteriorly placed lesions at the upper cervical region is not new, but is still infrequently used by neurosurgeons for lesions in this region. The indications and surgical methods vary widely, and there is much room for discussion of the technical details. We are reporting our experience with this technique in two patients; one is a traumatic odontoid fracture and another is a cervical epidural abscess.