1/23. Neonatal infectious spondylitis of the cervical spine presenting with quadriplegia: a case report.STUDY DESIGN: A case report.- OBJECTIVE: To highlight the evaluation and treatment of neonatal infectious spondylitis of the cervical spine. SUMMARY OF BACKGROUND DATA: Most authors advise intravenous antibiotics as first-choice treatment. The place of aspiration or operative drainage is debated, as is the position and duration of immobilization. methods: A 3-week-old neonate was presented with intermittent quadriplegia. RESULTS: Additional investigation demonstrated an osteolytic process in the body of C3 with a large epidural abscess compressing the spinal cord. Because an infectious spondylitis of C3 was suspected, aspiration of the abscess was performed, and antibiotic therapy was started. The patient improved to neurologically normal within 3 weeks and remains asymptomatic throughout a follow-up period of 7 years. CONCLUSIONS: Neonatal infectious spondylitis should be diagnosed early and treated promptly; otherwise, it may have devastating consequences.- - - - - - - - - - ranking = 1keywords = abscess (Clic here for more details about this article) |
2/23. Multiple nocardial abscesses of cerebrum, cerebellum and spinal cord, causing quadriplegia.In this paper we present a case of a diabetic patient with nocardial abscesses of cerebrum, cerebellum and the spinal cord. The present case is the first case in the literature of solitary intramedullary abscess in cervical spinal cord, causing tetraplegia. nocardia asteroides grew in a culture of the abscess pus. After either surgical excision or drainage of lesions, a triple combination regimen of chemotherapy (amikacin, ceftriaxone and trimethoprim-sulfamethoxazole) was given, but the patient was lost in the postoperative period. This case gives suggestive evidence of an association between cervical spinal cord involvement and poor prognosis in CNS nocardiosis.- - - - - - - - - - ranking = 3.5keywords = abscess (Clic here for more details about this article) |
3/23. Multifocal extensive spinal tuberculosis (Pott's disease) involving cervical, thoracic and lumbar vertebrae.An unusual case is reported of a 53-year-old woman presenting with spinal tuberculosis involving cervical, thoracic and lumbar vertebrae. The patient originally presented with progressive quadriparesis, fever, night sweats and weight loss. Imaging studies demonstrated vertebral body destruction with and without paraspinal and/or intraspinal abscess in cervical, thoracic and lumbar regions. The laboratory studies confirmed the diagnosis of Pott's disease and the patient was placed on anti-tuberculosis chemotherapy. The anterior approach was used for removal of the infected necrotic material, bone grafting and instrumentation, in both cervical and thoracic vertebrae. The postoperative course was uneventful and the patient made an excellent neurological recovery. The present report is of the first published case of an extensive spinal tuberculosis involving cervical, thoracic and lumbar spine.- - - - - - - - - - ranking = 0.5keywords = abscess (Clic here for more details about this article) |
4/23. Reversal of tetraplegia in patients with cervical osteomyelitis--epidural abscess using anterior debridement and fusion.OBJECTIVE: Aggressive anterior debridement and fusion has been advocated for the treatment of cervical osteomyelitis/epidural abscess (COEA) for many years. In this study we review our experiences with severely neurologically impaired (tetraplegic) patients with COEA. methods: From 1989-1999 we identified 20 cases of COEA treated with anterior debridement and fusion. patients were identified from a prospectively maintained database. All inpatient and outpatient records were reviewed. Six patients were identified as being tetraplegic prior to surgery. Tetraplegia was defined as complete absence or only flicker movement of the extremities. RESULTS: The age range was 41 to 74. There were five men and one woman. Anterior corpectomy and fusion with either iliac crest auto- or allograft was performed in all patients. In four of six patients an anterior cervical plate was utilized for internal fixation. Four of six patients were ambulatory at last follow-up. CONCLUSION: Aggressive debridement and fusion in patients with COEA can result in successful outcomes even in patients who are tetraplegic prior to surgery.- - - - - - - - - - ranking = 2.5keywords = abscess (Clic here for more details about this article) |
5/23. Occult maxillary sinusitis as a cause of fever in tetraplegia: 2 case reports.Common causes of fever in tetraplegia include urinary tract infection, respiratory complications, bacteremia, impaired autoregulation, deep vein thrombosis, osteomyelitis, drug fever, and intra-abdominal abscess. We report 2 acute tetraplegic patients who presented with fever of unknown origin. After extensive work-up, they were diagnosed with occult maxillary sinusitis. A search of current literature revealed no reports of sinusitis as a potential source of fever in recently spinal cord--injured patients. patients with tetraplegia, especially in the acute phase of spinal cord injury, often undergo nasotracheal intubation or nasogastric tube placement, which may result in mucosal irritation and nasal congestion. All of the previously mentioned factors, in combination with poor sinus drainage related to supine position, predispose them to developing maxillary sinusitis. The 2 consecutive cases show the importance of occult sinusitis in the differential diagnosis of fever in patients with tetraplegia.- - - - - - - - - - ranking = 0.5keywords = abscess (Clic here for more details about this article) |
6/23. Cervicothoracolumbar spinal epidural abscess with tetraparesis. Good recovery after non-surgical treatment with antibiotics and dexamethasone. Case report and review of the literature.We report the conservative treatment of a spinal epidural abscess (SEA) caused by escherichia coli and affecting the anterior epidural space from C2 to L4 in a diabetic, obese patient presenting with tetraparesis. The favourable clinical response to the administration of dexamethasone and antibiotics is described. We review the literature on non-surgical treatment of SEA with special regard to the use of corticosteroids.- - - - - - - - - - ranking = 2.5keywords = abscess (Clic here for more details about this article) |
7/23. Myelopathy due to spinal epidural abscess without cord compression: a diagnostic pitfall.Spinal epidural abscess (SEA) is a neurological emergency that requires urgent diagnosis and treatment. We report 2 patients with SEA, in whom, on neuropathological examination, the neurological signs were found to be caused by spinal cord ischemia due to thrombosis of leptomeningeal vessels and compression of spinal arteries, respectively, while evidence of spinal cord compression was absent. Clinicians and neuropathologists should be aware of the variable mechanisms underlying the neurological involvement in SEA. Absence of spinal cord compression by the abscess may hamper early diagnosis and treatment.- - - - - - - - - - ranking = 3keywords = abscess (Clic here for more details about this article) |
8/23. Transient quadriplegia following re-puncture of tracheo-oesophageal fistula.We present a case of a laryngectomized patient who underwent re-puncture of tracheo-oesophageal fistula for speaking valve voice restoration, resulting in a previously unreported inherent complication of this procedure: extradural abscess of the cervical spine with transient quadriplegia.- - - - - - - - - - ranking = 0.5keywords = abscess (Clic here for more details about this article) |
9/23. scedosporium apiospermum brain abscess treated with surgery and voriconazole. Case report.scedosporium apiospermum is a fungus found in the soil and in contaminated water. Common cutaneous manifestations include Madura foot, a painless swelling on the sole of the foot. Invasive infection is usually associated with immunosuppression. The authors present a 16-month-old immunocompetent boy who had a near-drowning event. Following this, he was severely disabled with spastic quadriparesis. Early computerized tomography scans revealed diffuse hypoxic injury. Magnetic resonance images obtained 3 months after the initial event demonstrated multiple ring-enhancing lesions in the brain. Aspiration of the lesion was performed. scedosporium apiospermum, the asexual form of pseudallescheria boydii, was cultured. Conventional antifungal agents were commenced, with minimal effect. The child was subsequently treated with a new antifungal agent, voriconazole, a broad-spectrum triazole antifungal agent with good penetration into the cerebrospinal fluid. The patient improved, with a good radiological outcome and a moderate clinical outcome. The authors review the use of voriconazole for central nervous system infections and review the literature on S. apiospermum associated with near drowning.- - - - - - - - - - ranking = 2keywords = abscess (Clic here for more details about this article) |
10/23. Pyogenic cervical spondylitis with quadriplegia as a complication of severe burns: Report of a case.We report a case of cervical pyogenic spondylitis complicated by epidural abscess with quadriplegia during treatment of severe burns. The patient was a 49-year-old man with 3rd-degree burns to 20% of his body, involving the lower extremities. We performed escharectomy of the 3rd-degree necrosis on days 7 and 16, followed by the first skin graft on day 23. pseudomonas aeruginosa was detected in the postoperative graft wound culture. On day 23 after the skin graft, he became febrile and began to experience cervical pain and muscle weakness of the extremities. By day 24, quadriplegia had developed. A cervical vertebral magnetic resonance imaging (MRI) scan showed pyogenic spondylitis with an epidural abscess, which was causing the quadriplegia. We treated the patient by performing curettage of the pyogenic lesion and anterior fixation of the cervical vertebral bodies. The fact that P. aeruginosa was detected in the pyogenic focus culture indicated that burn wound sepsis was responsible for the infection. This case reinforces that acting on a strong suspicion helps to establish a diagnosis and initiate appropriate treatment early.- - - - - - - - - - ranking = 1keywords = abscess (Clic here for more details about this article) |
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