1/50. Spinal epidural abscess complicating chronic epidural analgesia in 11 cancer patients: clinical findings and magnetic resonance imaging.We reviewed the records of all patients who had received an epidural catheter for management of chronic cancer pain in a 3-year period (1993-1996). patients with nervous system infections were identified, and pertinent clinical, radiological (magnetic resonance imaging), and bacteriological data were analyzed. We identified 11 patients who developed spinal epidural abscess (SEA). All of these had back pain; radicular signs occurred in seven patients and spinal cord compression in two patients. magnetic resonance imaging revealed SEA in all 11 patients. SEA was iso- to hypointense on T1-weighted images and hyperintense on T2-weighted images relative to spinal cord. After gadolinium administration seven lesions showed characteristic rim enhancement while three showed minimal enhancement. No signs of diskitis or osteomyelitis were present, and the abscess was always localized to the posterior epidural space. Cultures were positive in all cases and revealed staphylococcus epidermidis in eight and S. aureus in three. All patients were treated with intravenous antibiotics, and four had an additional decompressive laminectomy. Two patients died within 1 week of diagnosis from overwhelming septicemia despite apparently adequate antibiotic treatment. Within 4 weeks after diagnosis of SEA two patients died from widely metastatic disease, although infection may have contributed. One patient developed septicemia while receiving appropriate antibiotics and underwent emergency laminectomy. The neurological deficits recovered in all patients who survived the acute infectious episode. We conclude that patients with chronic epidural catheters for cancer pain require prompt neurological evaluation and magnetic resonance imaging when SEA is suspected. Early evaluation and treatment may lead to full recovery.- - - - - - - - - - ranking = 1keywords = back pain, back (Clic here for more details about this article) |
2/50. Atypical infective endocarditis.BACKGROUND: Although infective endocarditis has changed in the recent past as a result of microbiologic and risk factors, it continues to be clinically challenging. The disease is characterized by the formation of septic masses of platelets on the surfaces of heart valves. Several mechanisms can cause or contribute to the development of endocarditis. Although risk factors for infective endocarditis are well known, patients with atypical signs and symptoms continue to challenge us. methods: We describe a case report of a patient admitted to our inpatient service with back pain and presumed pyelonephritis. A medline literature search was conducted, using the key words "endocarditis," "back pain," and "bacterial," for the years 1986 to the present. RESULTS AND CONCLUSIONS: A 42-year-old woman with a history of intravenous drug abuse was admitted to the family practice service with back pain and pyelonephritis. She developed hypoxia and a new heart murmur and had continued fevers. blood cultures drawn in the emergency department grew methicillin-resistant staphylococcus aureus. A bone scan and magnetic resonance imaging led to the diagnosis of epidural abscess. What appeared to be a simple case of pyelonephritis with back pain became a case of infective endocarditis complicated by an epidural abscess.- - - - - - - - - - ranking = 4keywords = back pain, back (Clic here for more details about this article) |
3/50. epidural abscess in an obstetric patient.epidural abscess is a rare complication of epidural block and occasionally presents in the post partum period. A case is described where a thoracolumbar abscess presented with backache and headache 10 days after an apparently uneventful block for labour and caesarean section. The abscess was treated medically with a satisfactory outcome. The literature is reviewed in order to assess several recent reports of infectious complications of epidural block in obstetric patients.- - - - - - - - - - ranking = 0.051150524483432keywords = back (Clic here for more details about this article) |
4/50. Enlargement of a chronic aseptic lumbar epidural abscess by intraspinal injections--a rare cause of progressive paraparesis.The frequent use of invasive procedures at the spinal cord such as epidural injections has led to an increased incidence of iatrogenic abscesses. We report the case of a patient who suffered from low back pain. During epidural lumbar injections of steroids the patient developed severe radicular symptoms, resulting in severe paraparesis. We demonstrate the rare cause of this progressive deterioration, being a combination of a preexisting chronic aseptic epidural abscess and an iatrogenic enlargement by repeated epidural injections. MR-Scans demonstrated a mass lesion at the L4/5 vertebral level, which was surgically removed. Histological evaluation revealed the presence of a chronic aseptic spinal epidural abscess with acute bleedings. histology and MR-Data disclosed multiple deposits of the applied drug within the abscess and in the surrounding paravertebral soft tissue. The authors prove that the cause of the neurological deterioration was due to epidural injections into a preexisting lumbar chronic aseptic epidural abscess. Harmful and unpleasant complications may occur following epidural injections. Though we present a very rare cause of such complications, a careful monitoring of the neurological status of the patient is necessary as well as the early application of MR imaging in the case of deterioration.- - - - - - - - - - ranking = 5.350175391268keywords = low back pain, back pain, low back, back (Clic here for more details about this article) |
5/50. Acute neurologic deterioration following lumbar puncture in an epidural abscess occurring 14 months after epidural catheter placement.We report the case of a 19-year-old girl admitted to the hospital with a 2-month history of back pain and a 1-week history of severe weakness, who underwent a diagnostic lumbar puncture which was swiftly followed by acute neurologic deterioration requiring ventilation. She was subsequently shown to have an epidural abscess extending from the second cervical to the fifth lumbar vertebrae. She had received uneventful epidural analgesia for childbirth 14 months previously. The case is unusual in both the acute deterioration following lumbar puncture, and also in the length of time from epidural siting to abscess formation, if this were indeed the source of the infection.- - - - - - - - - - ranking = 1keywords = back pain, back (Clic here for more details about this article) |
6/50. Inappropriate medical management of spinal epidural abscess.A 67 year old man with longstanding rheumatoid disease was referred to the regional spinal surgery unit with acute onset of paraparesis due to an extensive spinal epidural abscess of the lumbar spine. Ten months previously, he had started antibiotic treatment at another hospital for an epidural abscess arising at the level of the L2-3 disc space. Despite completing seven months of medical treatment with appropriate antibiotics, he had a recrudescence of acute back pain shortly after restarting methotrexate treatment. Urgent anterior spinal decompression with excision of the necrotic vertebral bodies of L1-3 was performed. The indications for the surgical management of spinal epidural abscess are reviewed.- - - - - - - - - - ranking = 1keywords = back pain, back (Clic here for more details about this article) |
7/50. Septic arthritis of a lumbar facet joint due to pyonex.We present a case of septic arthritis of a lumbar facet joint with an associated epidural abscess. A 13-year-old boy was hospitalized with acute severe back pain and fever after pyonex was done. The infection was precisely localized with magnetic resonance imaging, bone and gallium scintigraphy. He responded to antibiotic therapy. We suppose that the infection was caused by pyonex because the blood cultures were negative, and the patient had an abrupt onset of severe pain and fever 24 h after the acupuncture.- - - - - - - - - - ranking = 1keywords = back pain, back (Clic here for more details about this article) |
8/50. Case report: catheter-related epidural abscess.INTRODUCTION: Catheter-related spinal epidural abscesses are rare but increasing in incidence. CLINICAL PICTURE: An elderly gentleman received 4 days of continuous epidural analgesia following multiple traumatic rib fractures. Five days subsequently, he developed an extensive epidural abscess accompanied by backache, lower limb weakness, fever, leukocytosis and Staphylococcal bacteraemia. TREATMENT: He received appropriate intravenous antibiotics and underwent an emergent decompressive laminectomy. OUTCOME: A good outcome was achieved because of prompt diagnosis, appropriate intravenous antibiotics and timely surgical intervention. CONCLUSIONS: It is important to be vigilant and continue to maintain good clinical practice and a high index of suspicion for this procedural-related complication.- - - - - - - - - - ranking = 0.051150524483432keywords = back (Clic here for more details about this article) |
9/50. candida albicans spinal epidural abscess secondary to prosthetic valve endocarditis.A 56-year-old woman, with underlying rheumatic heart disease status post mitral valve replacement, presented with fever, low back pain radiating to right leg, and congestive heart failure. magnetic resonance imaging detected an L5-S1 spinal epidural abscess. A vegetation on prosthetic mitral valve was found by transesophageal echocardiography. Cultures of epidural aspirate, surgical specimen, and blood all grew candida albicans. She received surgical drainage of the spinal epidural abscess and i.v. amphotericin b 1 mg/kg/day for eight weeks. Clinical symptoms improved gradually and she was discharged without neurologic sequelae. She remained well and continued to lead an active life two years after discharge.- - - - - - - - - - ranking = 5.350175391268keywords = low back pain, back pain, low back, back (Clic here for more details about this article) |
10/50. Spinal epidural abscess due to streptococcus pneumoniae in an hiv-infected adult.Spinal epidural abscess (SEA) due to streptococcus pneumoniae is rare and has never been reported in an hiv-infected patient, despite the higher risk of invasive disease in this group. We describe here the first case of pneumococcal epidural abscess, presenting with fever and back pain in a 60-year-old man infected with hiv. blood cultures were positive for S. pneumoniae and magnetic resonance imaging (MRI) confirmed the suspicion of diskitis and SEA at the L4-S1 level. The patient was successfully treated with iv ceftriaxone without surgical intervention. The clinical characteristics of this case are compared with existing literature on pneumococcal SEA.- - - - - - - - - - ranking = 1keywords = back pain, back (Clic here for more details about this article) |
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