neurologic disorders
Spinal Epidural Abscess
Diagnosis of Spinal Epidural Abscess
MRI Because rapid treatment is necessary to prevent or minimize neurologic deficits, clinicians should consider spinal epidural abscess if patients have significant atraumatic back pain, particularly when there is focal percussion tenderness over the spine, or if they have a fever or have had a recent infection or dental procedure. Characteristic neurologic deficits are more specific but may occur later, so delaying imaging until these neurologic deficits are present can make a poor outcome more likely. Consider immediate MRI to diagnose spinal epidural abscess if patients have unexplained back pain, even without neurologic findings, particularly if focal percussion tenderness and risk factors (eg, IV drug use, recent infection or bacteremia) are present. Diagnosis of spinal epidural abscess is by MRI. Myelography followed by CT may be used if MRI is not available. Clinicians should consider doing MRI immediately if patients have unexplained back pain, even without neurologic findings, particularly if they have focal percussion tenderness and risk factors (eg, IV drug use, recent infection or bacteremia). Samples from blood and infected areas are cultured. The presence of an inflamed disk (discitis) can help distinguish an abscess from a metastatic tumor. Discitis typically precedes abscess formation, whereas a metastatic tumor does not affect the disk; it destroys nearby bone. Lumbar puncture is contraindicated because it may trigger cord herniation if the abscess completely obstructs flow of cerebrospinal fluid (CSF). Plain x-rays are not routinely indicated but show osteomyelitis in about one third of patients. Erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) is elevated, but this finding is nonspecific. 