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E-Pearl of the Week: Spinal Epidural Abscess

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Brought to you by the Residents & Fellows Section of Neurology®.

April 25, 2013

Spinal epidural abscesses are suppurative infections arising in the extradural space of the spinal cord or cauda equina. Mechanism of infection includes hematogenous spread, contiguous extension, and direct innoculation. In this condition, the most common presenting signs and symptoms are fever, neck or back pain, and focal neurologic deficits [1]. MRI with contrast confirms the diagnosis. Treatment includes rapid neurosurgical drainage and empirical antimicrobial therapy. Clinical suspicion for spinal epidural abscesses is imperative as the infection can progress rapidly resulting in spinal cord compression, paralysis, and death. Prognosis is dependent on time to diagnosis, with motor deficits present in 45% of patients who had delays in diagnosis, compared to 13% of patients identified early [2].

References

  1. Curry WT Jr, Hoh BL, Amin-Hanjani, Eskandar EN. Spinal epidural abscess: clinical presentation, management, and outcome. Surgical Neurology. 2005; 64: 364-371.
  2. Davis DP, Wold RM, Patel RJ, et al.  The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess.  2004; 26: 285-291.

Submitted by Adam Numis, M.D. Resident Physician, University of California, San Francisco.

Disclosure: Dr. Numis is a member of the Resident and Fellow Section of Neurology.

For more clinical pearls and other articles of interest to neurology trainees, visit the Neurology Residents & Fellows page.  Listen to this week's Neurology Podcast.

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