Widespread Lumbosacral Subdural Abscess after Bee Venom Therapy: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: We report a case of widespread lumbosacral subdural abscess in a patient who underwent bee venom therapy. SUMMARY OF LITERATURE REVIEW: Subdural abscess is rare, but has a poor prognosis. Therefore, prompt recognition and appropriate treatment are paramount. MATERIALS AND METHODS: A 54-year-old woman was hospitalized due to severe back pain. Two days previously, she had undergone bee venom therapy. The patient then visited the emergency room because of severe back pain. However, a paraspinal infection was not detected on enhanced magnetic resonance imaging (MRI). Six days after admission, the patient showed signs of meningeal irritation and an emergency cerebrospinal fluid analysis showed typical findings of bacterial meningitis. Although adequate antibiotic treatment was administered, 20 days after admission, the patient's symptoms became aggravated. Pachymeningeal enhancement, myelomeningitis, and subdural abscess compressing the cauda equina were found on enhanced MRI. Thus, laminectomy between L3–L4 and L5–S1 was performed, as well as subdural abscess drainage. Antibiotic agents were applied for 6 weeks after the operation, and resolution of the subdural abscess was identified on follow-up MRI. RESULTS: In this patient, lumbosacral subdural abscess occurred due to bee venom therapy. It was cured by adequate surgical and antibiotic treatment. CONCLUSIONS: Bee venom therapy can cause subdural abscess of the spinal cord. Even if it is a rare case, this possibility is worth consideration in the Korean medical context.

Absceso vertebral subdural a Staphylococcus aureus

Los abscesos vertebrales y paravertebrales constituyen una urgencia médica neuroquirúrgica, siendo el absceso espinal subdural una forma rara de presentación. La etiología más frecuente es Staphylococcus aureus. La manifestación clínica habitual es un compromiso medular y fiebre. El diagnóstico se confirma con la resonancia magnética nuclear con gadolinio. Presentamos un paciente previamente sano que consulta con un cuadro agudo de compromiso medular y fiebre en quien la resonancia magnética nuclear evidenció un absceso subdural vertebral y compromiso paravertebral. Se realizó una intervención quirúrgica rápida y recibió terapia dirigida al germen aislado con evolución favorable.

Spinal and paraspinal abscesses are a neurosurgical medical emergency, being the spinal subdural abscess a rare form of presentation. The most common ethiologic agent is Staphylococcus aureus. The usual clinical manifestations are medullary involvement and fever. The diagnosis is confirmed by magnetic resonance imaging with gadolinium. We report a previously healthy patient that consulted for an acute case of medullary involvement and fever in whom MRI showed a spinal subdural abscess and paraspinal commitment. A quick surgical intervention was performed and the patient received therapy targeted at the isolated germ with favorable evolution

Subdural empyma due to Mycobacterium fortuitum in a non-HIV patient.

A 14‑year‑old male child presented with high grade intermittent fever with altered sensorium since 5‑6 days and generalised seizures. On examination neck stiffness noticed with normal haemogram and chest X‑ray. CSF microscopy was normal and no growth seen in aerobic culture. CT scan showed loculated lesion. Drained pus showed acid fast organism and culture on Lowestein Jensen medium showed pale‑coloured growth on 3rd day. Organism identified as Mycobacterium fortuitum by biochemical test. Interesting aspect of this case was there is no history of trauma or injection and patient was negative for HIV antibody.

Simultaneous Subperiosteal and Subdural Abscesses Occurred as Complications of Acute Sinusitis

Acute sinusitis is a common medical problem which can result in serious complications if it is not managed appropriately. The most common complication of acute sinusitis is orbital complication, followed by intracranial complications. Concomitant involvement of the orbit and the brain as complications of acute sinusitis is very rare. We were presented with a case of a 27-year-old woman who suffered from subperiosteal abscess in the orbit and subdural abscess in the frontal area. Endoscopic sinus surgery, drainage of the subperiosteal abscess through eyebrow incision and drainage of the subdural abscess through craniotomy were performed. The postoperative course was uneventful, and the patient was free of ocular and neurologic symptoms at the eight month follow-up.

Subdural Abscess in a Patient with Epidural Abscess Combined with Dural Tear / 대한정형외과학회잡지

Abscesses of the epidural and subdural spine are relatively rare, but can rapidly progress and cause paraplegia; the mortality rate is high despite improvements in treatment method. In particular, the reoccurrence of subdural abscesses after treatment of an epidural abscess is extremely rare. We experienced a case in which the subdural abscess reoccurred after spinal decompression and drainage of an epidural abscess combined with a dural tear. We report this rare case with a review of the relevant literatures.

Infección intracraneal y rinosinusitis aguda: reporte de tres casos pediátricos / Intracranial infection and acute rhinosinusitis: three pediatric cases report

La rinosinusitis es una infección común en la población pediátrica, y entre sus complicaciones está la infección intracraneal que se relaciona con alta morbilidad y mortalidad. Es imprescindible un alto índice de sospecha para llegar así al diagnóstico temprano y brindar el tratamiento antibiótico y quirúrgico necesario. Presentamos nuestra experiencia de tres pacientes pediátricos con infección intracraneal secundaria a rinosinusitis.

Rhinosinusitis is a common infection in children and can present with intracranial complications associated with high morbidity and mortality. A high index of suspicion is essential to reach an early diagnosis, confirming it with imaging studies and initiating appropriate antibiotic and surgical treatment. Herein our experience with three pediatric patients with intracranial infection as a result of acute sinus infection has been presented.

A Case of Spinal Subdural Abscess Spreading from a Epidural Abscess

We report a case of spinal subdural abscess spreading from a epidural abscess. A 70-year-old man was hospitalized for a mild fever, chill and severe back pain. Neurological examination on admission revealed back pain with numbness, sensory deficiency on left lower extremity and without bowel or bladder dysfunction. Lumbar magnetic resonance imaging(MRI) showed pyogenic spondylitis on L1, 2, 3 with epidural abscess. A patient was treated by empiric antibiotic therapy for 6 weeks. Six weeks later, follow-up MRI showed that the pyogenic spondylitis with epidural abscess had decreased, but a cylinder like subdural abscess after arachnoiditis. After surgery, the majority of the initial symptoms were relieved except a mild both lower extremities numbness.

A Case of Sinusitis-Induced Intracranial Complication / 대한이비인후과학회지

Sinusitis is a common problem that is routinely diagnosed and treated by most primary care physicians. Although most cases usually respond to appropriate therapy, some occasionally progress to the development of intracranial complications, including meningitis, osteomyelitis, epidural and subdural empyema, intracranial mucocele or polyps, and frank brain abscess. It is important to develop a rational approach to the diagnosis and treatment of these conditions. Intracranial complications are pathologically caused by direct extension of the disease through the bony defect or hematogenous spread. Radiologic evaluation must include computerized tomography for accurate diagnosis and surgical planning. Therapy includes surgical drainage and high doses of intravenous antibiotics. Recently we have experienced one subdural abscess secondary to acute sinusitis.

Clinical Observation of Intracranial Abscesses

Sixty five intracranial abscesses were experienced from December , 1970 to August, 1981, of which fifty seven cases were operated. The clinical analysis and surgical experiences were summarized as follows. 1) The patients consisted of 45 male and 12 female and 31 patients(54.4%) were under 20 years of age. 2) Of the 57 patients, 45 patients(79%) had a demonstrable infectious source leading to the intracranial infection. There were 15 patients with ear infection and 13 patients with trauma. 3) Staphylococcus and streptococcus were the most common pathogens in this study. 4) Common symptoms of the patients were headache and fever, which were followed by mental disturbance and focal neurologic disturbance. 5) Brain CT scan offered accurate, non-invasive, rapid and easily repeatable means of diagnosis and following of lesions. After contrast infusion, ring enhancement had mostly thin and regular wall(88%). 6) The best operative methods of the brain abscess were aspiration and resection, or drainage and resection. The deep seated brain abscess, subdural abscess and epidural abscess could be treated using only drainage method with good results.