Epidural abscess medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
Several studies have reached the conclusion that the best approach to [[therapy]] of [[epidural abscess]], either intracranial or spinal, is a combination of [[surgical]] drainage along with systemic [[antibiotics]]. Due to the importance of preoperative neurologic status, along with the unpredictable rate of progression of neurologic impairment, for the neurological outcome of the patient, "decompressive laminectomy and debridement of infected tissues should take place as soon as possible". <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><ref name="pmid1359381">{{cite journal| author=Darouiche RO, Hamill RJ, Greenberg SB, Weathers SW, Musher DM| title=Bacterial spinal epidural abscess. Review of 43 cases and literature survey. | journal=Medicine (Baltimore) | year= 1992 | volume= 71 | issue= 6 | pages= 369-85 | pmid=1359381 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1359381 }} </ref> | Several studies have reached the conclusion that the best approach to [[therapy]] of [[epidural abscess]], either intracranial or spinal, is a combination of [[surgical]] drainage along with systemic [[antibiotics]]. Due to the importance of preoperative neurologic status, along with the unpredictable rate of progression of neurologic impairment, for the neurological outcome of the patient, "decompressive laminectomy and debridement of infected tissues should take place as soon as possible". <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><ref name="pmid1359381">{{cite journal| author=Darouiche RO, Hamill RJ, Greenberg SB, Weathers SW, Musher DM| title=Bacterial spinal epidural abscess. Review of 43 cases and literature survey. | journal=Medicine (Baltimore) | year= 1992 | volume= 71 | issue= 6 | pages= 369-85 | pmid=1359381 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1359381 }} </ref> However, in certain clinical scenarios, medical therapy may be the only treatment indicated for that particular case, these include: | ||
*decompressive laminectomy declined by the patient | |||
*high operative risk | |||
*paralysis unlikely irreversible, due to being present for more than 24 to 26 hours | |||
*panspinal infection, therefore the laminectomy would be impracticable. | |||
==References== | ==References== | ||
Revision as of 05:37, 27 March 2014
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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. Due to the fact that the initial symptoms and clinical characteristics are not always identical and are similar to 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. According to the location of the collection, the abscess may have different origins, different organisms involved, symptoms, evolutions, complications and therapeutical techniques. [2] The treatment of epidural abscess focuses in two main aspects: reduction of the inflammatory mass; and eradication of the responsible organism. These goals can be reached through a combination of therapeutical approaches, including: aspiration, drainage and antibiotic therapy. An early surgical decompression and drainage, followed by an aggressive antibiotic treatment is the ideal procedure to increase the chances of a better outcome.
Medical Therapy
Several studies have reached the conclusion that the best approach to therapy of epidural abscess, either intracranial or spinal, is a combination of surgical drainage along with systemic antibiotics. Due to the importance of preoperative neurologic status, along with the unpredictable rate of progression of neurologic impairment, for the neurological outcome of the patient, "decompressive laminectomy and debridement of infected tissues should take place as soon as possible". [3][4] However, in certain clinical scenarios, medical therapy may be the only treatment indicated for that particular case, these include:
- decompressive laminectomy declined by the patient
- high operative risk
- paralysis unlikely irreversible, due to being present for more than 24 to 26 hours
- panspinal infection, therefore the laminectomy would be impracticable.
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.
- ↑ Darouiche, Rabih O. (2006). "Spinal Epidural Abscess". New England Journal of Medicine. 355 (19): 2012–2020. doi:10.1056/NEJMra055111. ISSN 0028-4793.
- ↑ Darouiche RO, Hamill RJ, Greenberg SB, Weathers SW, Musher DM (1992). "Bacterial spinal epidural abscess. Review of 43 cases and literature survey". Medicine (Baltimore). 71 (6): 369–85. PMID 1359381.