ABSTRACT
Introducción: el absceso epidural posterolateral y la compresión radicular es una rara complicación del absceso retrofaríngeo (ARF). Se realizó el reporte de un caso con esta complicación extremadamente rara. Método: reporte de caso y revisión de la literatura (estudios radiológicos, historia y hallazgos clínicos). Se firmó consentimiento del paciente para la publicación. Resultados: paciente de 33 años remitido a nivel terciario de atención con un cuadro clínico de cervicalgia, odinofagia y fiebre. La tomografía axial computarizada (TAC) y la resonancia magnética nuclear (RMN) mostraron una colección retrofaríngea con compromiso epidural en el espacio medular cervical; en el examen físico se encontró odinofagia, cervicalgia, fiebre y pérdida de la fuerza muscular en el miembro superior derecho. El paciente fue llevado a manejo quirúrgico por otorrinolaringología y ortopedia para el drenaje de la colección; además, se le administró antibioticoterapia con cefepime y clindamicina por 21 días con buenos resultados; se consideró que el origen del absceso era idiopático. Conclusiones: el absceso epidural y la compresión radicular secundarias a un ARF es una rara y potencialmente mortal complicación de esta patología, con secuelas importantes en el paciente que la padece, que requiere un manejo médico-quirúrgico. En nuestro caso el manejo fue interdisciplinario, ya que integró otorrinolaringología, ortopedia, infectología y fisioterapia, lo que resultó en una evolución satisfactoria del paciente.
Introduction: posterolateral epidural abscess and radicular compression is a rare complication of retropharyngeal abscess (RFA), a case report with this extremely rare complication was made. Method: case report and review of the literature (radiological studies, clinical history, clinical findings) patient's consent was signed for the publication. Results: a 33-year-old patient referred at the tertiary care level with a clinical picture of cervicalgia, odynophagia and fever; CT and MRI showed retropharyngeal collection with epidural involvement in the cord cervical space, physical examination, odynophagia, cervicalgia, fever and loss of muscle strength in the right upper limb. Led to surgical management by ENT and orthopedics column for drainage of the collection; antibiotic therapy with cefepime, clindamycin for 21 days with good results; It was considered of idiopathic origin. Conclusions: epidural abscess and root compression secondary to an RFA is a rare and potentially fatal complication of this pathology with important sequelae in the patient, which requires medical-surgical management, in our case the management was integrated interdisciplinary otolaryngology, orthopedics, infectology, physiotherapy , with satisfactory evolution in the patient.
Subject(s)
Humans , Male , Adult , Spinal Cord , Staphylococcal Infections/complications , Retropharyngeal Abscess/complications , Epidural Abscess/etiology , Nerve Compression Syndromes/etiology , Staphylococcal Infections/therapy , Staphylococcal Infections/diagnostic imaging , Staphylococcus aureus/isolation & purification , Retropharyngeal Abscess/therapy , Retropharyngeal Abscess/diagnostic imaging , Epidural Abscess/therapy , Epidural Abscess/diagnostic imaging , Nerve Compression Syndromes/therapy , Nerve Compression Syndromes/diagnostic imagingABSTRACT
Abstract Brucellosis, a zoonosis with worldwide distribution, is a systemic infection caused by bacteria of the genus Brucella. Meanwhile, brucellosis often causes complications, such as osteoarticular involvement, and spondylitis is the most prevalent and important clinical form. Here, is a case of cervical brucellar spondylitis causing incomplete limb paralysis in a middle-aged male. The diagnosis was based on clinical history, and supported by Brucella serology and magnetic resonance imaging. Quadruple antibacterial treatment continued for four weeks. In this case, the epidural abscess causing spinal cord compression resolved without surgery. In addition, the patient had recovered from most of the neurologic deficits.
Subject(s)
Humans , Male , Paralysis/etiology , Spondylitis/diagnosis , Brucellosis/diagnosis , Epidural Abscess/etiology , Spondylitis/complications , Brucellosis/complications , Magnetic Resonance Imaging , Cervical Vertebrae , Middle AgedABSTRACT
INTRODUCTION: The presence of an active bacteremia has been considered a relative contraindication to perform an intrathecal puncture due to the risk of causing meningitis or epidural abscess. However, a clear and definite causal relationship has not yet been demonstrated. OBJECTIVES: To determine the relationship between intrathecal puncture and the development of meningitis in sub-jects with bacteremia. MATERIALS AND METHODS: Experimental study in rats with chronic bacteremia to which dural puncture was performed. Meningitis was then evaluated by direct drainage of the cisterna magna and histopathological studies of brain tissue. RESULTS AND CONCLUSION: 12 of 40 bacteremic rats that underwent intrathecal puncture developed meningitis. Previous administration of antibiotics seems to reduce this risk.
INTRODUCCIÓN: Se ha considerado la presencia de una bacteremia activa como contraindicación relativa para realizar una punción intratecal por el riesgo de provocar meningitis o absceso peridural. Sin embargo, aún no se ha podido demostrar una relación causal clara y definida. OBJETIVOS: Determinar la relación entre punción intratecal y el desarrollo de meningitis en sujetos con bacteremia. MATERIALES Y MÉTODOS: Estudio experimental en ratas con bacteremia crónica a las que se les realizó punción dural, luego se evaluó la presencia o no de meningitis mediante drenaje directo de la cisterna magna y estudios histopatológicos de tejido cerebral. RESULTADOS Y CONCLUSIÓN: 12 de 40 ratas bacterémicas a las que se le realizó punción intratecal desarrollaron meningitis. La adminis-tración previa de antibiótico parece disminuir este riesgo.
Subject(s)
Animals , Rats , Spinal Puncture/adverse effects , Meningitis, Bacterial/etiology , Bacteremia/complications , Epidural Abscess/etiology , Anesthesia, Spinal/adverse effects , Reproducibility of Results , Rats, Sprague-Dawley , ContraindicationsABSTRACT
Summary Spondylodiscitis affecting the cervical spine is the most unusual type. Disease progression can be dramatic, even causing quadriplegia and death. We present an unusual case that progressed with osteolytic lesions between C2 and C3, causing cord compression and epidural abscess. The patient was treated surgically by a double approach and improved without neurological deficits and with better inflammatory markers. We reviewed the current literature on the subject.
Resumo A espondilodiscite, que acomete a coluna cervical, é a de localização mais rara. Pode ter uma evolução dramática, inclusive causando tetraplegia e óbito. Apresentamos um caso atípico que evoluiu com lesões osteolíticas entre C2 e C3, causando compressão medular e abscesso epidural. O paciente foi submetido a tratamento cirúrgico por dupla abordagem e evoluiu bem, sem déficits neurológicos e com melhora dos marcadores inflamatórios. Revisamos a literatura vigente sobre o assunto.
Subject(s)
Humans , Male , Spondylitis/diagnostic imaging , Staphylococcal Infections/complications , Staphylococcus aureus , Discitis/diagnostic imaging , Cervical Vertebrae/microbiology , Spinal Cord Compression/etiology , Spondylitis/complications , Spondylitis/microbiology , Staphylococcal Infections/diagnosis , Magnetic Resonance Imaging , Discitis/complications , Discitis/microbiology , Tomography, X-Ray Computed , Epidural Abscess/etiology , Middle AgedABSTRACT
RESUMO A rinossinusite aguda é uma das afecções mais prevalentes das vias aéreas superiores. Fatores anatômicos presentes em crianças e jovens propiciam o aparecimento de complicações orbitárias. Embora mais raras, as complicações intracranianas das rinossinusites perfazem um grau alto de letalidade, são mais comuns em pacientes acima de sete anos, e devem ser tratadas por uma equipe multidisciplinar.
ABSTRACT Acute rhinosinusitis is one of the most prevalent diseases of the upper airways. Anatomical factors present in children and young people allow for the onset of orbital complications. Although rare, intracranial complications of sinusitis account for a high degree of lethality, are more common in patients over the age of seven, and should be treated by a multidisciplinary team.
Subject(s)
Humans , Female , Child , Orbital Diseases/etiology , Orbital Diseases/diagnostic imaging , Sinusitis/complications , Epidural Abscess/etiology , Epidural Abscess/diagnostic imaging , Orbital Diseases/surgery , Periosteum/pathology , Sinusitis/diagnostic imaging , Tomography, X-Ray Computed , Drainage/methods , Acute Disease , Epidural Abscess/surgery , Abscess/surgery , Abscess/etiology , Abscess/diagnostic imagingABSTRACT
El empiema epidural espinal (EEE) es una infección supurada del sistema nervioso central, predomina en el sexo masculino y en la edad media de la vida. El microorganismo mayormente implicado es Staphylococcus aureus. Alcanza el espacio epidural por contigüidad, inoculación directa o diseminación a distancia. Se manifiesta con fiebre, dolor espinal y déficit neurológico. Se presentan tres casos de EEE y se realizan consideraciones clínicas, microbiológicas y terapéuticas.
Abstract Spinal epidural empyema is a suppurating infection of the central nervous system, more frequent in male patients and during the midlife stage. Staphylococcus aureus is the most commonly found microorganism. It reaches the epidural space extending contiguously, by direct inoculation or distant spread. It manifests with fever, spinal pain and neurological deficit. Three cases of spinal epidural empyema are presented and clinical, microbiological and therapeutic considerations are made.
Resumo O empiema epidural espinal (EEE) é uma infecção supurada do sistema nervoso central, predominante no sexo masculino e na meia idade. O micro-organismo implicado na maioria dos casos é o Staphylococcus aureus. Atinge o espaço epidural por contiguidade, inoculação direta ou disseminação a distancia. Manifesta-se com febre, dor espinal e déficit neurológico. Apresentam-se três casos de EEE e fazem-se considerações clínicas, microbiológicas e terapêuticas.
Subject(s)
Humans , Epidural Abscess/diagnosis , Epidural Abscess/etiology , Epidural Abscess/therapy , Spinal Cord CompressionABSTRACT
Transarterial chemoembolization (TACE) is one of the most effective therapies for unresectable hepatocelluar carcinoma or metastatic hypervascular tumors. Abscess occurring in the other organs beside the liver after TACE is a complication that often occurs, sometimes potentially fatal. We report a case of spinal epidural abscess occurred after liver abscess complicated by TACE in a patient with metastatic neuroendocrine tumors to the liver. A 67-year-old female underwent TACE first for the metastatic lesions to liver, with a history of pancreatoduodenectomy for the primary pancreatic neuroendocrine tumor. Four days after TACE, sudden high fever occurred, and liver abscess was found on abdominal CT. Two days later, back pain and radiating pain to the right leg occurred, and lumbar spine MRI showed spinal epidural abscess. After intravenous antibiotics for 8 weeks and partial laminectomy, the patient recovered and was discharged without complications.
Subject(s)
Aged , Female , Humans , Anti-Bacterial Agents/therapeutic use , Carcinoma, Hepatocellular/secondary , Chemoembolization, Therapeutic/adverse effects , Epidural Abscess/etiology , Escherichia coli/isolation & purification , Escherichia coli Infections/drug therapy , Laminectomy , Liver Abscess/etiology , Liver Neoplasms/secondary , Lumbar Vertebrae/microbiology , Magnetic Resonance Imaging , Neuroendocrine Tumors/pathology , Pancreaticoduodenectomy , Tomography, X-Ray ComputedABSTRACT
O abscesso extradural da coluna vertebral tem sido considerado raro. Sua incidência é de 0,2 a 2 casos por 10.000 internações/ano. O presente trabalho apresenta uma revisão sobre abscesso extradural da coluna vertebral, analisando causas, quadro clínico, exames de neuroimagens, tratamento e prognóstico. Trata-se de artigo de revisão baseado em levantamento nas bases de dados Medline/PubMed e SciELO, em que foram analisados os artigos mais relevantes a respeito desse assunto. Foram selecionados 66 artigos, nos quais são analisados fatores predisponentes, localização anatômica, quadro clínico, exames complementares, tratamento e prognóstico. Acomete mais indivíduos idosos e do sexo masculino. Os principais fatores predisponentes são: diabetes mellitus, pacientes imunodeprimidos e intervenções cirúrgicas na coluna vertebral. As condições clínicas pré-operatórias, intervenção cirúrgica precoce, antibioticoterapia apropriada e reabilitação intensiva são fatores determinantes no prognóstico em abscesso extradural da coluna vertebral.
Extradural abscess in spine is considered rare. Its incidence is 0.2 to 2 cases in 10.000 hospitalization/year. The present research presents a review about extradural abscess in spine, analyzing causes, clinical state, neuroimaging exams, treatment and prognosis. It?s a review article based in Medline/PubMed and SciELO data, were analyzed the most relevant articles about the present subject. It was analyzed 66 articles, analyzing predisposing factors, anatomical location, clinical state, complementary exams, treatment and diagnosis. Affects mainly the elderly and males. The main predisposing factors are: diabetes mellitus, immunodepressed patients and surgical intervention in spine. Clinical pre-operative conditions, precocious surgical intervention, appropriate antibiotic therapy and intensive rehabilitation are determinant in prognosis of spine extradural abscess.
Subject(s)
Humans , Male , Aged , Epidural Abscess/diagnosis , Epidural Abscess/etiology , Epidural Abscess/therapy , Spine , Magnetic Resonance Imaging , Spinal Cord CompressionABSTRACT
Spinal epidural abscess (SEA) is an uncommon condition and its most important predisposing factor is diabetes mellitus. Although the treatment of choice is prompt surgical abscess evacuation, followed by antibiotic therapy, successful conservative treatment of SEA has been reported in some cases. We describe a SEA case in a 23-year old white woman with diabetes for 14 years, who was successfully treated only with antibiotics, and achieved full recovery at the fourth month of follow-up.
O abscesso epidural espinhal (AEE) é uma doença incomum e o diabetes melito é o seu fator predisponente mais importante. O tratamento de escolha é a imediata drenagem cirúrgica, seguida de antibioticoterapia, entretanto, casos já foram relatados em que o AEE foi tratado clinicamente com sucesso. Descrevemos um caso de AEE em um paciente diabético tratado satisfatoriamente com uso isolado de antibióticos e que evoluiu com recuperação total no quarto mês de seguimento.
Subject(s)
Female , Humans , Young Adult , Amikacin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Clindamycin/therapeutic use , Diabetes Complications/drug therapy , Epidural Abscess/drug therapy , Diabetes Complications , Epidural Abscess/etiology , Epidural Abscess , Treatment OutcomeABSTRACT
Brucellosis remains a diagnostic puzzle. We retrospectively studied the case notes of 105 patients with brucellosis who were admitted in the Department of Internal Medicine of the University of Patras Hospital, a tertiary care institution serving an extended rural area in western Greece, from 2003 to 2006. Five unusual causes of brucellosis were identified: hepatic, epidural and thyroid abscesses, intrahepatic cholestatic liver disease and pancytopenia. Virtually every human organ and system can be involved in brucellosis, which highlights the need to include brucellosis in the differential diagnosis, especially in endemic areas
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Brucellosis/complications , Epidural Abscess/etiology , Retrospective Studies , Liver Diseases/etiology , Magnetic Resonance ImagingSubject(s)
Epidural Abscess/diagnosis , Epidural Abscess/epidemiology , Epidural Abscess/etiology , Epidural Abscess/prevention & control , Epidural Abscess/therapy , Anesthesia, Conduction/adverse effects , Anesthesia, Conduction/methods , Asepsis/instrumentation , Asepsis/methods , Anti-Infective Agents, Local , Catheterization/adverse effects , Diagnosis, Differential , Magnetic Resonance Spectroscopy , Incidence , Infection Control , Infections/etiology , Central Nervous System Infections/diagnosis , Central Nervous System Infections/therapy , Immunosuppression Therapy/adverse effects , Meningitis/diagnosis , Meningitis/epidemiology , Meningitis/etiology , Meningitis/therapy , Protective Devices , Risk FactorsSubject(s)
Humans , Epidural Abscess/epidemiology , Anesthesia, Local/adverse effects , Meningitis, Bacterial/epidemiology , Epidural Abscess/diagnosis , Epidural Abscess/etiology , Epidural Abscess/therapy , Anesthesia, Epidural/adverse effects , Asepsis/methods , Incidence , Meningitis, Bacterial/diagnosis , Meningitis, Bacterial/etiology , Meningitis, Bacterial/therapy , Risk FactorsABSTRACT
El absceso epidural espinal es un proceso infeccioso caracterizado por la acumulación de material purulento y tejido de granulación en el espacio epidural. Se trata de una complicación poco frecuente, cuyo diagnóstico habitualmente se demora, lo cual se asocia con elevada morbimortalidad. Cuando el agente etiológico es Mycobacterium tuberculosis, la fiebre prolongada y el dolor dorsolumbar son los síntomas más comunes. La resonancia magnética es el método de elección para el diagnóstico de la localización y extensión del proceso. El diagnóstico precoz seguido del tratamiento específico (descompresión neuroquirúrgica y tuberculostáticos) son necesarios para mejorar el pronóstico de estos pacientes y evitar secuelas neurológicas definitivas.
Subject(s)
Humans , Female , Adult , Epidural Abscess/diagnosis , Epidural Abscess/etiology , Mycobacterium tuberculosis , BoliviaSubject(s)
Humans , Male , Female , Anesthesia, Epidural/adverse effects , Anesthesia, Epidural/instrumentation , Anesthesia, Epidural/methods , Epidural Space , Thoracic Vertebrae , Epidural Abscess/diagnosis , Epidural Abscess/epidemiology , Epidural Abscess/etiology , Epidural Abscess/microbiology , Anesthesia, General/methods , Catheters, Indwelling , Dura Mater/injuries , Hematoma, Epidural, Spinal/diagnosis , Hematoma, Epidural, Spinal/epidemiology , Hematoma, Epidural, Spinal/etiology , Hematoma, Epidural, Spinal/therapy , Intraoperative Complications , Magnetic Resonance Spectroscopy , Pleura/injuries , Risk Factors , Thoracic SurgeryABSTRACT
We present a very rare mode of presentation of brucellosis. A patient who presented with history of left sciatica followed by features of acute cauda equina compression was found to have brucellar spinal epidural abscess. The case report and review of literature is presented
Subject(s)
Humans , Male , Brucellosis/complications , Epidural Abscess/etiology , Epidural Abscess/diagnosis , Spine , Brucella , Sciatica , Cauda EquinaABSTRACT
Apesar de sua significativa diminuição após o advento dos antibióticos, as complicações intracranianas das otites médias ainda representam uma situação de risco, uma vez que a taxa de mortalidade permanece alta, chegando a 36 por cento. Entre as formas mais comuns estão meningite, abscesso cerebral, abscesso extradural e tromboflebite do seio lateral. Um alto índice de suspeição é fundamental para seu diagnóstico e manejo precoces. É importante a identificação de casos atípicos que podem estar mascarados pelo uso de antimicrobianos. OBJETIVO: Apresentamos seis casos de complicações intracranianas por otite média em crianças e adolescentes ocorridos no período de dois anos no Serviço de Otorrinolaringologia do Complexo Hospitalar Santa Casa (CHSC). FORMA DE ESTUDO: relato de série.
Subject(s)
Humans , Male , Female , Child , Adolescent , Brain Diseases/etiology , Otitis Media, Suppurative/complications , Brain Abscess/etiology , Epidural Abscess/etiology , Cholesteatoma, Middle Ear/complications , Fatal Outcome , Meningitis/etiology , Thrombophlebitis/etiologyABSTRACT
Although cervical epidural abscess is rare, it should be strongly suspected in any patient with unexplainable neck pain and fever, especially when the patient has a predisposing factor for this infectious process. The authors report a case of cervical epidural abscess in a 39-yr-old man with an aorto-duodenal fistula, which complicated the interposition of artificial graft for abdominal aortic aneurysm rupture, which had undertaken 40 months before. Timely detection and intervention rendered him a full neurological recovery. This extremely rare case is presented with a literature review.