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Holocord spinal epidural abscess in a pregnant patient presenting as premature labour: a rare presentation of an unusual diagnosis

Published online by Cambridge University Press:  04 March 2015

Kirsteen R. Burton ,
Xi Wang  and
Deljit Dhanoa
Kirsteen R. Burton*
Affiliation:
Institute of Health, Policy, Management and Evaluation Medical Imaging, University of Toronto, Toronto, ON Biostatistics, University of Toronto, Toronto, ON
Xi Wang
Affiliation:
Department of Diagnostic Radiology, McMaster University, Hamilton, ON
Deljit Dhanoa
Affiliation:
Medical Imaging, University of British Columbia, Fraser Health Authority, Vancouver, BC
*
Department of Radiology, Faculty of Medicine, University of British Columbia, 3350-950 W 10th Avenue, Vancouver BC V5Z 4E3; [email protected]

Abstract

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Spinal epidural abscess (SEA) is a rare clinical entity. It is less common when the entire epidural space is involved, known as a holocord or panspinal SEA, and it is even less common in a pregnant patient. We report a case of methicillin-resistant Staphylococcus aureus holocord SEA in a 30-year-old female at approximately 22 weeks' gestational age who presented with lumbar pain and pelvic pressure and the urge to bear down. Magnetic resonance imaging of the spine demonstrated extensive SEA and meningitis from the foramen magnum to the lumbar spine that was treated both medically and surgically. The incidence of, clinical presentation of, and risk factors for developing SEA are discussed. If untreated, expanding SEAs produce sensory symptoms and signs, motor dysfunction, and, eventually, paralysis and death. The medical and surgical management of SEA is also discussed. SEA can have an insidious and atypical presentation despiteextensive involvement of the epidural space. Therefore, the diagnosis of SEA should always be considered in patients who present to the emergency department with back pain.

Keywords

back painemergencyepidural abscessmagnetic resonance imagingmethicillin-resistantStaphylococcus aureusosteomyelitispregnancy
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 4 , July 2014 , pp. 334 - 338
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1. Wessling, H, de las Heras, P. Cervicothoracolumbar spinal epidural abscess with tetraparesis. Neurochirurgia 2003;14:529–33.Google ScholarPubMed
2. Baker, AS, Ojemann, RG, Swartz, MN, Richardson, EP Jr. Spinal epidural abscess. N Engl J Med 1975;293:463–8, doi:10.1056/NEJM197509042931001.CrossRefGoogle ScholarPubMed
3. Hllavin, M, Kaminski, H, Ross, J. Spinal epidural abscess. A ten-year perspective. Neurosurgery 1990;27:177–84, doi:10.1227/00006123-199008000-00001.CrossRefGoogle Scholar
4. Pilkingon, SA, Jackson, SA, Gillett, GR. Spinal epidural empyema. Br J Neurosurg 2003;17:196–200, doi:10.1080/0268869031000108990.CrossRefGoogle Scholar
5. Darouiche, RO. Spinal epidural abscess. N Engl J Med 2006;355:2012–20, doi:10.1056/NEJMra055111.CrossRefGoogle ScholarPubMed
6. Pradilla, G, Pradilla Ardila, G, Hsu, W, Rigamonti, D. Epidural abscesses of the CNS. Lancet Neurol 2009;8:292–300, doi:10.1016/S1474-4422(09)70044-4.CrossRefGoogle ScholarPubMed
7. Del Curling, OJ, Gower, D, McWhorter, J. Changing concepts in spinal epidural abscess: a report of 29 cases. Neurosurgery 1990;27:185–92, doi:10.1227/00006123-199008000-00002.CrossRefGoogle ScholarPubMed
8. Rea, G, McGregor, J, Miller, C. Surgical treatment of the spontaneous spinal epidural abscess. Surg Neurol 1992;37: 274–9, doi:10.1016/0090-3019(92)90152-D.CrossRefGoogle ScholarPubMed
9. Rigamonti, D, Liem, L, Sampath, P. Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Spine 1999;52:189–97.Google ScholarPubMed
10. Deardre, C, Nanda, A. Spinal epidural abscess: a diagnostic challenge. Am Fam Physician 2002;65:1341–6.Google Scholar
11. Harrington, P, Millner, P, Veale, D. Inappropriate medical management of spinal epidural abscess. Ann Rheumatol Dis 2001;60:218–22, doi:10.1136/ard.60.3.218.CrossRefGoogle ScholarPubMed
12. Lu, C, Chang, W, Lui, C. Adult spinal epidural abscess: clinical features and prognostic factors. Clin Neurol Neurosurg 2002;104:306–10, doi:10.1016/S0303-8467(02)00020-3.CrossRefGoogle ScholarPubMed
13. Xiao, B, Wang, C, Lin, J. Successful medical treatment of spinal epidural abscess. J Microbiol Immunol 2008;41:180–2.Google ScholarPubMed
14. Davis, DP, Wold, RM, Patel, RJ, et al. The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess. J Emerg Med 2004;26:285–91, doi:10.1016/j.jemermed.2003.11.013.CrossRefGoogle ScholarPubMed
15. Davis, DP, Salazar, A, Chan, TC, Vilke, GM. Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain. J Neurosurg Spine 2011;14: 765–70. [Epub 2011 Mar 18], doi:10.3171/2011.1.SPINE1091.CrossRefGoogle Scholar
16. Panagiotopoulos, V, Konstantinou, D, Solomou, E. Extended cervicolumbar spinal epidural abscess associated with paraparesis successfully decompressed using a minimally invasive technique. Spine 2004;29:E300–3, doi:10.1097/01.BRS.0000131215.46119.DD.CrossRefGoogle ScholarPubMed
17. Riaz, S, Mahmood, JK. Extensive spinal epidural abscess. J Ayub Med Coll Abbottabad 2007;19(2):64–7.Google ScholarPubMed
18. Schultz, KD Jr, Comey, CH, Haid, RW Jr. Technical note. Pyogenic spinal epidural abscess: a minimally invasive technique for multisegmental decompression J Spinal Disord Tech 2001;14:546–9, doi:10.1097/00002517-200112000-00015.CrossRefGoogle ScholarPubMed