Subject(s)
Discitis/diagnostic imaging , Epidural Abscess/diagnostic imaging , Tuberculosis, Spinal/diagnostic imaging , Adult , Antitubercular Agents/therapeutic use , Discitis/cerebrospinal fluid , Discitis/complications , Epidural Abscess/cerebrospinal fluid , Epidural Abscess/complications , Humans , Magnetic Resonance Imaging , Male , Medication Adherence , Paraplegia/etiology , Syndrome , Thoracic Vertebrae/diagnostic imaging , Thrombophilia/complications , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Spinal/cerebrospinal fluid , Tuberculosis, Spinal/complicationsABSTRACT
A 67-year-old man under hemodialysis treatment developed neck stiffness, fever and conscious disturbances. The patient was infected with Methicilin-resistant Staphylococcus aureus (MRSA) sepsis caused by an infection on a dialysis shunt. On admission, he was diagnosed with bacterial meningoencephalitis and underwent a series of antibiotic chemotherapies. The treatment brought cell count in the cerebrospinal fluid to a subnormal level but his clinical status did not improve. The patient continued to have high level of cerebrospinal fluid protein (898 mg/dl). Cervical MRI demonstrated two abscesses deep in the neck as well as in the epidural region of the cervical spinal cord, from C2 to C5 vertebral levels. Based on these findings, spinal epidural abscess (SEA) was diagnosed. Intensive antibiotic chemotherapy especially targeted for MRSA could eradicate abscesses and improve clinical status. However, persistent high protein level in the cerebrospinal fluid could suggest SEA.
Subject(s)
Cerebrospinal Fluid Proteins/cerebrospinal fluid , Epidural Abscess/cerebrospinal fluid , Methicillin Resistance , Staphylococcal Infections/cerebrospinal fluid , Staphylococcus aureus/drug effects , Aged , Epidural Abscess/diagnosis , Epidural Abscess/microbiology , Humans , Magnetic Resonance Imaging , Male , Renal Dialysis , Tomography, X-Ray ComputedABSTRACT
We report on a 70-year-old female with acute onset of headache, meningism, xanthochromic cerebrospinal fluid, and developing laboratory parameters indicating a systemic infection. Initially, a subarachnoidal hemorrhage was assumed. However, magnetic resonance imaging showed upper cervical osteomyelitis and extending spinal epidural abscess. After application of broad systemic antibiotics, secluded abscess formation was achieved and successful neurosurgical debridement performed. The unusual cranial concentration of the complaints is probably due to the involvement of the craniocervical transition. Cervical epidural spinal abscess represents a potentially dangerous bacterial infection of the upper spine. Inadequate treatment can lead to irreversible neurological deficits. Cervical magnetic resonance imaging is an effective tool for diagnosis, since early diagnosis is important for good prognosis.
Subject(s)
Cervical Vertebrae , Epidural Abscess/complications , Epidural Abscess/diagnosis , Headache/etiology , Meningism/etiology , Osteomyelitis/complications , Osteomyelitis/diagnosis , Aged , Epidural Abscess/cerebrospinal fluid , Female , Headache/diagnosis , Humans , Incidental Findings , Meningism/diagnosis , Methemoglobin/cerebrospinal fluid , Osteomyelitis/cerebrospinal fluidABSTRACT
Cerebrospinal fluid (CSF) is normally of low signal intensity on T1 weighted MRI. The case of a patient with renal failure who developed an epidural abscess, and in whom the CSF appeared of high signal intensity on delayed T1 weighted MRI is presented. Possible mechanisms for this are discussed.
