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TREATMENT

Immediate correction of coagulopathy (when present) and surgical decompression

Spinal Epidural Abscess

Typically results from hematogenous spread of infection to epidural space;

most common organism is Staphylococcus aureus

Major risk factors include:

■ Injection drug use

■ Chronic renal failure

■ Dental abscess

■ Bacterial endocarditis

■ Alcoholism

■ Diabetes

■ Immunosuppression

■ Recent back surgery, lumbar puncture, or epidural anesthesia

SYMPTOMS/EXAM

■ Progressive pain

■ Constitutional symptoms: Fevers, sweats

■ Weakness, loss of bowel/bladder and sensory deficits depending on degree

of compression

NEUROLOGY

TABLE 15.14. Clinical Features and Etiology of Spinal Cord Disorders

SPINALCORDDISORDER CLINICALFEATURES ETIOLOGY

Diskitis Back pain, fever, and refusal to walk in Inflammatory process in disc (viral or

child <10 years S aureus)

Dorsal column disorders Loss of position sense, vibration, and Syphilis or vitamin B 12 deficiency

light touch

HIV myelopathy Weakness, gait problems, spasticity, Advanced HIV

sphincter dysfunction

Neoplasm Severe pain with radiation down spine Most common—lung cancer, breast cancer,

Signs of cord compression lymphoma

Spinal epidural abscess Severe pain with radiation down spine Expanding abscess (IDU or

Signs of cord compression, fever immunocompromise)

Spinal epidural hematoma Severe pain with radiation down spine, Expanding hemorrhage (trauma or

signs of cord compression coagulopathy)

Syringomyelia Disassociative anesthesia, weakness Syrinx formation in central spinal cord

Transverse myelitis Transverse level of sensory loss, paresis, Post-viral or toxic inflammation

sphincter dysfunction