Epidural abscess history and symptoms: Difference between revisions
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Despite being an important finding, [[fever]] may not be always present. A possible explanation for this absence it the [[analgesic]] drugs most patients are on, at the time of presentation, for the accompanying [[back pain]]. Therefore, this triad might not be present at all times.<ref name="pmid3589332">{{cite journal| author=Danner RL, Hartman BJ| title=Update on spinal epidural abscess: 35 cases and review of the literature. | journal=Rev Infect Dis | year= 1987 | volume= 9 | issue= 2 | pages= 265-74 | pmid=3589332 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3589332 }} </ref> If untreated, the symptoms usually evolve in a specific order and their progression, within hours to days or months, may be described according to 4 stages: <ref>{{Cite book | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages = }}</ref><ref name="Darouiche2006">{{cite journal|last1=Darouiche|first1=Rabih O.|title=Spinal Epidural Abscess|journal=New England Journal of Medicine|volume=355|issue=19|year=2006|pages=2012–2020|issn=0028-4793|doi=10.1056/NEJMra055111}}</ref> | Despite being an important finding, [[fever]] may not be always present. A possible explanation for this absence it the [[analgesic]] drugs most patients are on, at the time of presentation, for the accompanying [[back pain]]. Therefore, this triad might not be present at all times.<ref name="pmid3589332">{{cite journal| author=Danner RL, Hartman BJ| title=Update on spinal epidural abscess: 35 cases and review of the literature. | journal=Rev Infect Dis | year= 1987 | volume= 9 | issue= 2 | pages= 265-74 | pmid=3589332 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3589332 }} </ref> If untreated, the symptoms usually evolve in a specific order and their progression, within hours to days or months, may be described according to 4 stages: <ref>{{Cite book | last1 = Mandell | first1 = Gerald L. | last2 = Bennett | first2 = John E. (John Eugene) | last3 = Dolin | first3 = Raphael. | title = Mandell, Douglas, and Bennett's principles and practice of infectious disease | date = 2010 | publisher = Churchill Livingstone/Elsevier | location = Philadelphia, PA | isbn = 0-443-06839-9 | pages = }}</ref><ref name="Darouiche2006">{{cite journal|last1=Darouiche|first1=Rabih O.|title=Spinal Epidural Abscess|journal=New England Journal of Medicine|volume=355|issue=19|year=2006|pages=2012–2020|issn=0028-4793|doi=10.1056/NEJMra055111}}</ref> | ||
#[[Back pain|back]] and focal [[vertebral]] pain, with [[tenderness]] on [[physical exam]]. | |||
#[[Nerve root]] [[pain]], radiating from affected areas, sometimes accompanied by [[paresthesia]]. | |||
#Dysfunction of the [[spinal cord]], presenting by motor and sensory deficits and [[sphincter]] incompetence. | |||
#[[Paralysis]]. | |||
==References== | ==References== | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]
Overview
An epidural abscess is a rare suppurative infection of the central nervous system, a collection of pus localised in the epidural space lying outside the dura mater, which accounts for less than 2% of focal CNS infections. [1] It may occur in two different places: intracranially or in the spinal canal. Because the initial symptoms and clinical characteristics are not always identical and are similar to the ones in other diseases, along with the fact that they are both rare conditions, the final diagnosis might be delayed in time. This late diagnosis comes at great cost to the patient, since it is usually accompanied by a bad prognosis and severe complications with a potential fatal outcome. The diagnosis of epidural abscess should be first suspected from the clinical findings and posteriorly supported by laboratory tests and imaging studies, however it can only be confirmed after surgical drainage and proper study of the collected material. According to the location of the collection, the abscess may have different origins, different organisms involved, symptoms, evolutions, complications and therapeutical techniques. [2][3]
History and Symptoms
Intracranial Epidural Abscess
Patients with this tip of epidural abscess usually complain of: [4]
Spinal Epidural Abscess
Patients with this type of epidural abscess usually present with very unspecific symptoms. However, a triad has been described;
- Fever
- Neurologic deficits
- Spinal pain
Despite being an important finding, fever may not be always present. A possible explanation for this absence it the analgesic drugs most patients are on, at the time of presentation, for the accompanying back pain. Therefore, this triad might not be present at all times.[5] If untreated, the symptoms usually evolve in a specific order and their progression, within hours to days or months, may be described according to 4 stages: [6][3]
- back and focal vertebral pain, with tenderness on physical exam.
- Nerve root pain, radiating from affected areas, sometimes accompanied by paresthesia.
- Dysfunction of the spinal cord, presenting by motor and sensory deficits and sphincter incompetence.
- Paralysis.
References
- ↑ Longo, Dan L. (Dan Louis) (2012). Harrison's principles of internal medici. New York: McGraw-Hill. ISBN 978-0-07-174889-6.
- ↑ Danner, R. L.; Hartman, B. J. (1987). "Update of Spinal Epidural Abscess: 35 Cases and Review of the Literature". Clinical Infectious Diseases. 9 (2): 265–274. doi:10.1093/clinids/9.2.265. ISSN 1058-4838.
- ↑ 3.0 3.1 Darouiche, Rabih O. (2006). "Spinal Epidural Abscess". New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 0028-4793.
- ↑ Fountas KN, Duwayri Y, Kapsalaki E, Dimopoulos VG, Johnston KW, Peppard SB; et al. (2004). "Epidural intracranial abscess as a complication of frontal sinusitis: case report and review of the literature". South Med J. 97 (3): 279–82, quiz 283. PMID 15043336.
- ↑ Danner RL, Hartman BJ (1987). "Update on spinal epidural abscess: 35 cases and review of the literature". Rev Infect Dis. 9 (2): 265–74. PMID 3589332.
- ↑ Mandell, Gerald L.; Bennett, John E. (John Eugene); Dolin, Raphael. (2010). Mandell, Douglas, and Bennett's principles and practice of infectious disease. Philadelphia, PA: Churchill Livingstone/Elsevier. ISBN 0-443-06839-9.