ABSTRACT
Bacterial abscesses involving the spinal canal are associated with a high morbidity and mortality. Most frequently, these lesions are found in the epidural, rarely in the subdural spaces. Spinal subdural abscess is rare. The exact incidence of the spinal subdural abscess [SSA] is unknown and the most affected region is the thoraco-lumbar spine. The timing for MRI is very important when the clinician notices these symptoms in the patient. Early diagnosis and emergent treatment is vital to prevent the formation or progression of neurologic deficits. Although the most common bacterial source is Staphylococcus aureus, bacterial sources were proteus and E.coli in the patients. In this report, we presented four patients with SSA in the thoraco lumbar region. Over the last 10 years, four cases of spinal subdural abscess were admitted and treated at Tehran Children Medical Center. All of four cases were under 3 years old and surgically and medical treated. All four patients were received antibiotics for a period of 4-6 weeks and showed remarkable recovery
Subject(s)
Humans , Child, Preschool , Child , Epidural Abscess , Subdural Space/pathology , Staphylococcus aureus , Magnetic Resonance Imaging , Early Diagnosis , Incidence , Treatment OutcomeABSTRACT
A 43-year-old female presented with persistent headache and dizziness which had first occurred two years earlier. The physical and neurological findings at admission were unremarkable, though plain radiography revealed the presence of a dense calcified mass in the left frontal area, and CT showed that a homogeneous high-density nodule was attached to the inner surface of the left frontal skull. The hard bony mass found and excised during surgery was shown at histopathologic examination to be a subdural osteoma. We describe the clinicopathologic findings of this entity and discuss the radiological features which suggest its subdural location.
Subject(s)
Adult , Female , Humans , Frontal Bone/pathology , Osteoma/pathology , Skull Neoplasms/pathology , Subdural Space/pathology , Tomography, X-Ray ComputedABSTRACT
Preoperative diagnosis of free disc fragment is important in order to avoid treatment by chymopapain and percutaneous method of disc removal or anterior discectomy. This retrospective case analysis was to study the cause, physical findings and appropriate investigation to identify free disc fragment before surgery. One hundred and thirteen operative patients of herniated lumbar disc were studied. Of these, eleven patients (9.7%) were diagnosed with free disc fragment. The results revealed that one patient was diagnosed preoperatively with free disc fragment by myelography and MRI and three other patients using MRI alone. We concluded that preoperative diagnosis of free disc fragment can be made through identification of a large myelographic defect and/or sagittal scan MRI showing migration of disc material from native disc space.
Subject(s)
Adult , Aged , Diskectomy, Percutaneous/methods , Female , Foreign Bodies/diagnosis , Foreign-Body Migration/diagnosis , Humans , Intervertebral Disc Displacement/complications , Lumbar Vertebrae , Magnetic Resonance Imaging , Male , Middle Aged , Myelography , Preoperative Care , Retrospective Studies , Sensitivity and Specificity , Subdural Space/pathologyABSTRACT
Acute subdural hematoma (ASDH), chronic subdural hematoma (CSDH) and subdural hygroma (SDG) occur in the subdural space, usually after trauma. We tried to find a certain relationship among these three traumatic subdural lesions in 436 consecutive patients. We included all subdural lesions regardless of whether they were main or not. We evaluated the distribution, age incidence and interval from injury to diagnosis of these lesions, and the frequency of new subdural lesions in each lesion. ASDH constituted 68.6%, SDG 15.8%, and CSDH 15.6%, Age incidence of CSDH was similar to that of SDG, but differed from that of ASDH. Mean interval from injury to diagnosis was 0.4 days in ASDH, 13.4 days in SDG, and 51.6 days in CSDH. Focal brain injuries accompanied in 37.5% of ASDH, 5.8% of SDG, and no CSDH. In ASDH, 2 recurrent ASDHs, 17 SDGs and 9 CSDHs occurred. In SDG, 3 postoperative ASDHs and 8 CSDHs occurred. In CSDH, 2 postoperative ASDHs, 2 SDGs and 1 CSDH occurred. These results suggest that the origin of CSDH is not only ASDH, but also SDG in upto a half of cases. SDG is produced as an epiphenomenon by separation of the dural border cell layer when the potential subdural space is sufficient. A half of CSDHs may originate from ASDHs. ASDH may occur in CSDH by either a repeated trauma or surgery. Such transformation or development of new lesions is a function of a premorbid condition and the dynamics between the absorption capacity and expansile force of the lesion.
Subject(s)
Adolescent , Adult , Aged , Child , Female , Humans , Male , Age Factors , Brain Injuries/complications , Glasgow Coma Scale , Hematoma, Subdural/etiology , Middle Aged , Subdural Space/pathology , Tomography Scanners, X-Ray ComputedABSTRACT
A raridade do empiema subdural pode ser verificada pela escassez de casos descritos na literatura. Os autores apresentam mais um caso, mostrando as dificuldades diagnósticas principalmente quando näo há aparente porta de entrada. Enfatizam, nestas circunstâncias, a importância de certos sinais clínicos, o valor da punçäo lombar e da imagem por ressonância nuclear magnética na elucidaçäo diagnóstica. Este último exame näo foi mencionado anteriormente na literatura consultada sobre o assunto. O tratamento cirúrgico, associado à antibioticoterapia, mostrou-se bastante eficaz, principalmente se realizado precocemente