Epidural abscess

Epidural abscess
Spinal epidural abscess can form anywhere along the spinal canal. Risk factors for epidural abscess are represented by the impaired immune to such problems as diabetes, alcoholism, renal failure, malignant tumors. Other factors that may cause an abscess are infections with different locations or intravenous drugs. Most abscesses are caused by the release of a marrow or localized infections in the skin, such as boils or other tissues, the pharyngeal abscesses, dental or bacterial endocarditis. A series of favorable local conditions, like spinal osteomyelitis, decubitus ulcers, lumbar puncture or epidural anesthesia can cause a direct extension of germs in the subdural space. Bacteriological, mostly due to Staphylococcus aureus abscesses. There were also isolated and streptococci, gram-negative bacilli, anaerobes and fungi. In developing countries, tuberculosis remains a leading cause of spinal epidural abscess.
Symptoms In epidural abscess meets a clinical picture represented by the triad: pain, fever and rapidly progressing paresis. Pain is generally lively, located on spinal or paravertebral midline. If the abscess is not treated, the pain becomes permanent. Laboratory data indicate an increase of leucocytes and ESR's. Paresis rapidly progressive nature is itself due to thrombophlebitis or abscess in the epidural space which cause spinal cord compression.
Diagnostic Laboratory Among imaging examinations, MRI (magnetic resonance imaging) localized abscess best, making differential diagnosis with transverse myelitis or hematomielia. If one is suspected meningitis when lumbar puncture is done to study the cerebrospinal fluid. But in this case we must consider the risk of contamination of the subarachnoid space in case of an epidural abscess. Therefore, lumbar puncture is performed in such cases of cervical high. In the presence of subdural abscess, cerebrospinal fluid is rich in proteins, shows predominant Pleocytosis polimorfonuclearelor and glucose level is low.
Treatment In the case of small abscesses, and consists of medical treatment is antibiotics orally or by injection. Antibiotics will be in accordance with the results of culturing. If the abscess is large, compressive phenomena will occur with surgery. Treatment consists of surgical debridement and decompression laminectomy. Pre-and postoperatively will be given an antibiotic for at least 4 weeks. Surgical evacuation of the abscess contents dramatically improves patient evolution, brushing often paralysis.