Book contents
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Clinical Syndromes – General
- Part II Clinical Syndromes – Head and Neck
- Part III Clinical Syndromes – Eye
- Part IV Clinical Syndromes – Skin and Lymph Nodes
- Part V Clinical Syndromes – Respiratory Tract
- Part VI Clinical Syndromes – Heart and Blood Vessels
- Part VII Clinical Syndromes – Gastrointestinal Tract, Liver, and Abdomen
- Part VIII Clinical Syndromes – Genitourinary Tract
- Part IX Clinical Syndromes – Musculoskeletal System
- Part X Clinical Syndromes – Neurologic System
- 73 Bacterial Meningitis
- 74 Aseptic Meningitis Syndrome
- 75 Acute Viral Encephalitis
- 76 Intracranial Suppuration
- 77 Spinal Epidural Abscess: Diagnosis and Management
- 78 Myelitis and Peripheral Neuropathy
- 79 Reye's Syndrome
- 80 Progressive Multifocal Leukoencephalopathy
- 81 Cerebrospinal Fluid Shunt Infections
- 82 Prion Diseases
- Part XI The Susceptible Host
- Part XII HIV
- Part XIII Nosocomial Infection
- Part XIV Infections Related to Surgery and Trauma
- Part XV Prevention of Infection
- Part XVI Travel and Recreation
- Part XVII Bioterrorism
- Part XVIII Specific Organisms – Bacteria
- Part XIX Specific Organisms – Spirochetes
- Part XX Specific Organisms – Mycoplasma and Chlamydia
- Part XXI Specific Organisms – Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific Organisms – Fungi
- Part XXIII Specific Organisms – Viruses
- Part XXIV Specific Organisms – Parasites
- Part XXV Antimicrobial Therapy – General Considerations
- Index
77 - Spinal Epidural Abscess: Diagnosis and Management
from Part X - Clinical Syndromes – Neurologic System
Published online by Cambridge University Press: 05 March 2013
- Frontmatter
- Contents
- Preface
- Contributors
- Part I Clinical Syndromes – General
- Part II Clinical Syndromes – Head and Neck
- Part III Clinical Syndromes – Eye
- Part IV Clinical Syndromes – Skin and Lymph Nodes
- Part V Clinical Syndromes – Respiratory Tract
- Part VI Clinical Syndromes – Heart and Blood Vessels
- Part VII Clinical Syndromes – Gastrointestinal Tract, Liver, and Abdomen
- Part VIII Clinical Syndromes – Genitourinary Tract
- Part IX Clinical Syndromes – Musculoskeletal System
- Part X Clinical Syndromes – Neurologic System
- 73 Bacterial Meningitis
- 74 Aseptic Meningitis Syndrome
- 75 Acute Viral Encephalitis
- 76 Intracranial Suppuration
- 77 Spinal Epidural Abscess: Diagnosis and Management
- 78 Myelitis and Peripheral Neuropathy
- 79 Reye's Syndrome
- 80 Progressive Multifocal Leukoencephalopathy
- 81 Cerebrospinal Fluid Shunt Infections
- 82 Prion Diseases
- Part XI The Susceptible Host
- Part XII HIV
- Part XIII Nosocomial Infection
- Part XIV Infections Related to Surgery and Trauma
- Part XV Prevention of Infection
- Part XVI Travel and Recreation
- Part XVII Bioterrorism
- Part XVIII Specific Organisms – Bacteria
- Part XIX Specific Organisms – Spirochetes
- Part XX Specific Organisms – Mycoplasma and Chlamydia
- Part XXI Specific Organisms – Rickettsia, Ehrlichia, and Anaplasma
- Part XXII Specific Organisms – Fungi
- Part XXIII Specific Organisms – Viruses
- Part XXIV Specific Organisms – Parasites
- Part XXV Antimicrobial Therapy – General Considerations
- Index
Summary
Epidural abscess is an unusual but important cause of back pain. Because this infection is a potentially crippling but treatable condition, early diagnosis and aggressive therapy are essential for good outcomes. Even with an indolent presentation, infected patients can still suffer devastating neurological complications related to delays in recognition and appropriate intervention.
CLASSIFICATION
Epidural abscesses can be separated anatomically into infections involving the spinal or cranial epidural space. Cranial epidural abscesses are recognized complications of cranial surgery or trauma; they may also complicate otorhinological infections or procedures. Because of the distinct differences between cranial and spinal infections, cranial epidural abscess and the related subdural empyema will not be discussed in the following review.
Spinal epidural infections can often be segregated into acute and chronic presentations. This simple categorization correlates, albeit imperfectly, with certain clinical and laboratory manifestations, bacteriology, cerebrospinal fluid (CSF) formulae, anatomic details, pathology, and pathogenesis (Table 77.1). The nontuberculous bacterial spinal epidural abscess constitutes the major focus of this review. Tuberculous, fungal, and parasitic abscesses of the spinal epidural space typically evolve more insidiously than pyogenic bacterial epidural abscesses. Other than candidial infections, these etiologies are more frequently encountered in tropical and subtropical resource-constrained regions of the world. Metastatic carcinoma and lymphoma represent common alternative diagnoses that can exactly mimic epidural infections but mandate very different treatments.
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- Chapter
- Information
- Clinical Infectious Disease , pp. 541 - 546Publisher: Cambridge University PressPrint publication year: 2008