Epidural Abscess of spine

FACTS

 

HPI


Risk factors
distant infectious focus
Diabetes
IVDU
Alcoholism
Liver cirrhosis
onc history
rheum disease
steroid use
Advanced age
Immunosuppression
STI history

PHYSICAL EXAM

standard complete spine exam
check for meningismus
check for TTP

IMAGING

MRI pan-spine (see below)
A/P
  • Echo to r/o vegetations (started with transtracheal, ideally transesophageal)
  • MRI pan-spine w/wo - must image the entire spine before you operate
  • Surg ID consult
  • Blood cultures
  • Cervical/Thoracic EDA are operative emergencies: thrombophlebitis and cord ischemia can cause sudden irreversible paralysis
 
peripheral rim-enhancing ventral epidural abscess in a previously healthy young adult found to have MSSA bacteremia.
peripheral rim-enhancing ventral epidural abscess in a previously healthy young adult found to have MSSA bacteremia.