neurologic disorders
Spinal Epidural Abscess
Introduction
A spinal epidural abscess is an accumulation of pus in the epidural space that can mechanically compress the spinal cord. Diagnosis is by MRI or, if unavailable, myelography followed by CT. Treatment involves antibiotics and sometimes drainage of the abscess. (See also Overview of Spinal Cord Disorders .) Spinal epidural abscesses usually occur in the thoracic or lumbar regions. An underlying infection is often present; it may be remote (eg, endocarditis, furuncle, dental abscess) or contiguous (eg, vertebral osteomyelitis, pressure ulcer, retroperitoneal abscess). In about one third of cases, the cause cannot be determined. The most common causative organism isStaphylococcus aureus, followed byEscherichia coliand mixed anaerobes. Occasionally, the cause is a tuberculous abscess of the thoracic spine (Pott disease). Sometimes the cause is bacteremia due to medical instrumentation, a dental procedure, or injection drug use. Rarely, a similar abscess occurs in the subdural space. 