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May 24, 2013
Spinal Epidural Abscess
Spinal epidural abscesses are suppurative infections arising in the extradural space of the spinal cord or cauda equina. Mechanism of infection includes hematogenous spread, contiguous extension, and direct innoculation. In this condition, the most common presenting signs and symptoms are fever, neck or back pain, and focal neurologic deficits . MRI with contrast confirms the diagnosis. Treatment includes rapid neurosurgical drainage and empirical antimicrobial therapy. Clinical suspicion for spinal epidural abscesses is imperative as the infection can progress rapidly resulting in spinal cord compression, paralysis, and death. Prognosis is dependent on time to diagnosis, with motor deficits present in 45% of patients who had delays in diagnosis, compared to 13% of patients identified early .
Submitted by Adam Numis, M.D. Resident Physician, University of California, San Francisco.
Disclosure: Dr. Numis is a member of the Resident and Fellow Section of Neurology.
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