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World Neurosurg 2021 Jun 12. Epub 2021 Jun 12.

Department of Neurosurgery, University of New Mexico, School of Medicine MSC08, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA.

Objective: Spinal Epidural Abscess (SEA) patients have increased medical comorbidities and risk factors for infection compared to those without SEA. However, the association between frailty and SEA patients has not been documented.

Methods: 46 SEA patients were randomly paired and age/sex matched with control back pain patients who presented to our Emergency Department from 2012-2017. Read More

Indian J Orthop 2021 May 6;55(Suppl 1):176-181. Epub 2020 May 6.

Department of Orthopaedics, M S Ramaiah Medical College, Bangalore, India.

Background: In recent times due to the advancement of haemodialysis techniques, there is increase in the life span of the patients with end-stage renal disease, which tends to increase the risk of complications of bacteraemia due to skin penetration for blood access and leading to propensity for more skeletal and spinal complications. Hence, early diagnosis of spine infection and early initiation of appropriate therapy are important in ensuring successful treatment and preventing further morbidity.

Materials And Methods: The study included 22 males and 12 females who were known case of end-stage renal disease undergoing haemodialysis therapy and diagnosed with spondylodiscitis based on the clinical and radiological signs. Read More

J Bone Jt Infect 2021 2;6(6):207-209. Epub 2021 Jun 2.

Gustave Dron Hospital, 59200, Tourcoing, France.

A non-typeable (NTHi) was responsible for an invasive infection including bacteremia, spondylodiscitis with epidural abscess, and periprosthetic hip infection in a 79-year-old woman, triggered by a superinfected ethmo-orbital mucocele. Surgical drainage and antibiotic therapy allowed recovery. PET-scan full cartography of NTHi infection dissemination enabled the discovery of spondylodiscitis. Read More

Cureus 2021 May 3;13(5):e14820. Epub 2021 May 3.

Orthopaedic Department, Papageorgiou General Hospital of Thessaloniki, Thessaloniki, GRC.

Background Spondylodiscitis is a potentially life-threatening infection that imposes a significant financial burden on healthcare systems. Current reports suggest an increase in the incidence of spondylodiscitis, which could be attributed to the aging population and the growing rates of drug abuse. This study aims to evaluate the safety and effectiveness of surgical treatment of spondylodiscitis. Read More

Cureus 2021 Apr 9;13(4):e14376. Epub 2021 Apr 9.

Intensive Care Unit, Hospital Prof. Doutor Fernando Fonseca, Amadora, PRT.

Low back and cervical pain are common emergency department complaints. Most cases represent low-risk pathologies but in rare cases, it can be a symptom of a serious underlying disease and the distinction can be challenging. A case is reported of a 58-year-old male with recurrent cervical pain requiring several emergency department visits. Read More

BMJ Case Rep 2021 May 26;14(5). Epub 2021 May 26.

ENT & Head and neck surgery, All India Institute of Medical Sciences, New Delhi, India.

Sinogenic intracranial and orbital complications are infrequent complications of chronic rhinosinusitis with nasal polyposis (CRSwNP), leading to potentially fatal intracranial and orbital sequelae. The mortality and morbidity associated with these complications remain high despite the widespread use of antibiotics. We report a patient with CRSwNP presenting with acute onset extradural empyema and sixth nerve palsy in whom the diagnosis was delayed, necessitating early surgical intervention. Read More

Intern Med J 2021 May 24. Epub 2021 May 24.

Monash Infectious Disease, Monash Health, Victoria, Australia.

Background: People who inject drugs (PWID) are known to be at increased risk of infectious diseases including bacterial and blood-borne viral infections. However, there is limited literature surrounding the burden of spinal infections as a complication of injecting drug use (IDU).

Aims: To quantify the clinical and financial burden of IDU-related spinal infections. Read More

Cureus 2021 Apr 18;13(4):e14541. Epub 2021 Apr 18.

Emergency Medicine, Hamad Medical Corporation, Doha, QAT.

A spinal epidural abscess (SEA) is an uncommon disease, but it is associated with significant morbidity. SEA can be promoted by multiple risk factors. Moreover, the diagnosis of SEA usually requires the presence of a classic triad of back pain, fever, and neurological deficit, hence, the difficulty in making the diagnosis if presented otherwise. Read More

Front Neurol 2021 4;12:628256. Epub 2021 May 4.

Department of Neurosurgery, Goethe University Hospital, Frankfurt am Main, Germany.

The incidence of pyogenic spinal infection has increased in recent years. In addition to treatment of the spinal infection, early diagnosis and therapy of coexisting infections, especially of secondary brain infection, are important. The aim of this study is to elucidate the added value of routine cerebral imaging in the management of these patients. Read More

J Med Case Rep 2021 May 21;15(1):256. Epub 2021 May 21.

Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, Tochigi, 321-0293, Japan.

Background: The incidence of colorectal cancer in persons aged < 50 years has been increasing. The diagnosis of colorectal cancer is not difficult if the patient has typical symptoms; however, diagnosis may be difficult in cases with atypical symptoms and signs. We present here an atypical case of metastatic colorectal cancer with fever and sudden onset paraplegia as the sole manifestations. Read More

Int Med Case Rep J 2021 12;14:301-305. Epub 2021 May 12.

Hanoi Obstetrics and Gynecology Hospital, Hanoi, Vietnam.

Epidural abscess after obstetric epidural anesthesia occurs infrequently and may result in severe morbidity. We report a clinical case of an epidural abscess in Vietnam. A 31-year-old woman who was in labor was admitted to our hospital and given epidural anesthesia indicated to relieve labor pain. Read More

BMJ Case Rep 2021 May 19;14(5). Epub 2021 May 19.

Department of General Medicine, Saga University Hospital, Saga, Japan.

A 64-year-old woman was transferred to our hospital because of fever, painful swelling in upper jaw, back pain and dysuria. She was in shock and physical examinations revealed tenderness on maxillary sinus, cellulitis in the right foot, hypoesthesia in both lower extremities and groin, mild weakness in both lower extremities, and bladder and rectal dysfunctions. Blood examination showed elevated white cell count and C reactive protein, and urinalysis revealed urinary tract infection. Read More

Case Rep Infect Dis 2021 28;2021:9989847. Epub 2021 Apr 28.

Department of Microbiology, District General Hospital, Mannar, Sri Lanka.

Spinal-epidural abscess (SEA) is believed to be primarily of haematogenous origin and very rarely as a consequence of central neuraxial blockade. Early diagnosis and pertinent management invariably improve neurological outcomes. We report a case of long-segment SEA, which was suspected during subarachnoid anaesthesia, subsequently diagnosed and managed appropriately, averting irreversible neurological deficits. Read More

Spinal Cord Ser Cases 2021 May 13;7(1):38. Epub 2021 May 13.

Department of Orthopaedic Surgery, Toho University Sakura Medical Center, Sakura, Japan.

Introduction: Holospinal epidural abscess (HEA) extending from the cervical to the lumbosacral spine is an extremely rare condition. Surgical treatment of HEA, which involves extensive decompression of the spinal lesion is difficult in emergency settings. However, the authors successfully treated a case of HEA in critical condition with severe neurological deficits through a combination of skip decompression surgeries and catheter irrigation. Read More

Cureus 2021 Apr 5;13(4):e14293. Epub 2021 Apr 5.

Department of Pulmonary and Critical Care Medicine, Grand Strand Regional Medical Center, Myrtle Beach, USA.

Acute otomastoiditis is a potentially life-threatening condition. It is relatively uncommon in elderly patients and is usually seen as a complication of acute otitis media. Limited studies are available on this uncommon disease in the elderly, and thus the clinical course of the disease is not fully understood. Read More

Reg Anesth Pain Med 2021 May 6. Epub 2021 May 6.

Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA

Rev Soc Bras Med Trop 2021 28;54:e0134 2021. Epub 2021 Apr 28.

University of the Study of Campania "Luigi Vanvitelli", Department of Woman, Child and General and Specialized Surgery, Napoli, Italy.

Surg Neurol Int 2021 8;12:139. Epub 2021 Apr 8.

Department of Orthopedic Surgery, Akita University Graduate School of Medicine, Hondo, Japan.

Background: Pediatric spinal infections are rare and often accompanied by abscesses. Delayed diagnosis commonly leads to a poor neurological prognosis, emphasizing the need for early diagnosis and treatment.

Case Description: We report on two cases of spinal infection; one in a 5-year-old boy with a T8-11 epidural abscess and one in a 10-year-old boy with an L5-S1 epidural abscess. Read More

Pain Pract 2021 May 2. Epub 2021 May 2.

Department of Anesthesiology, University of Kansas Medical Center, Kansas City, Kansas, USA.

Spinal cord stimulation (SCS) is commonly utilized for treatment and management of chronic intractable low back and lower extremity pain. Although SCS is an overall low-risk procedure, there are potential life-threatening complications, including surgical site infections, such as an epidural abscess. Immunosuppression, a risk factor for epidural abscess, is becoming more common as an increasing number of patients are being treated with biologics for a multitude of autoimmune disorders. Read More

IDCases 2021 1;24:e01101. Epub 2021 Apr 1.

Department of General Internal Medicine, Hamad General Hospital, Doha, Qatar.

Brucellosis, is a zoonosis infection with a planetary distribution, caused by facultative intracellular bacteria of the genus Brucella, thus has a variable clinical presentation. Spinal epidural abscesses are a rare presentation of the disease, and may carry risk of a neurovascular compromise. Here we report a 22-year-old male with spinal brucellosis complicated by a cervical epidural abscess. Read More

Clin Infect Dis 2021 Apr 27. Epub 2021 Apr 27.

University of California San Francisco, San Francisco, CA, USA.

Background: Persons who use drugs (PWUD) face substantial risk of Staphylococcus aureus infections. Limited data exist describing clinical and substance use characteristics of PWUD with invasive S. aureus infections or comparing treatment and mortality outcomes in PWUD vs. Read More

Neurol Clin 2021 05;39(2):489-512

Division of Neurology, Lahey Hospital and Medical Center, Burlington, MA 01805, USA; Department of Neurology, Tufts University School of Medicine, Boston, MA 02111, USA. Electronic address:

Vascular and infectious causes are rare but important causes of spinal cord injury. High suspicion for these processes is necessary, as symptoms may progress over hours to days, resulting in delayed presentation and diagnosis and worse outcomes. History and clinical examination findings can assist with localization of the affected vascular territory and spinal level, which will assist with focusing spinal imaging. Read More

Am J Emerg Med 2021 Apr 19. Epub 2021 Apr 19.

Department of Emergency Medicine, Western Michigan University, Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-8060, United States of America.

Fever and low back pain with radicular symptoms raise concern for epidural abscess or other neuraxial infection, especially in the context of recent epidural anesthesia. Here we present an unusual case with several confounding factors and an unexpected diagnosis. Read More

BMJ Case Rep 2021 Apr 9;14(4). Epub 2021 Apr 9.

Neuro Orthopedic Center, La Source College of Health, Lausanne, Vaud, Switzerland.

A 57-year-old immunocompetent male patient presented himself to our emergency department with lumbar pain for 10 days, after a lumbar torsion. He was neurologically intact, but showed signs of systemic inflammatory syndrome. A lumbar MRI found a spinal epidural abscess from L3-L4 to L5-S1 levels. Read More

BMJ Case Rep 2021 Apr 8;14(4). Epub 2021 Apr 8.

Anesthesiology and Critical Care Medicine, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA

Pregnancy in patients with spinal cord injury presents unique challenges to their care teams. While spinal cord injury alters the function of several organ systems, one of the most important consequences is autonomic dysreflexia. Anaesthesia providers must be familiar with the pathophysiology and management of gravid patients with spinal cord injury to manage their deliveries successfully. Read More

J Equine Vet Sci 2021 04 13;99:103387. Epub 2021 Jan 13.

Department of Veterinary Medicine, Veterinary Teaching Hospital, University of Perugia, Perugia, Italy; Sport Horse Research Centre, University of Perugia, Perugia, Italy.

Pararectal abscesses are life-threatening conditions that can rupture and cause septic peritonitis. The objective of this case report is to describe aggressive treatment of a pararectal abscess to allow a quick return to competitions. A 14-year-old pony was admitted to the Veterinary Teaching Hospital (VTH) of the University of Perugia because of a suspected intra-abdominal mass. Read More

Surg Neurol Int 2021 2;12:83. Epub 2021 Mar 2.

Department of Neurosurgery, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.

Background: Spinal infections can be challenging in their management and include spondylitis, epidural abscess, and spondylodiscitis. Usual treatment is conservative through antimicrobials or surgery to decompress neural tissue, debride all infected tissues, and fix if needed. We propose the concept of surgery without formal debridement aiming at neural protection. Read More

Arch Rheumatol 2020 Dec 7;35(4):614-617. Epub 2020 Feb 7.

Department of Physical Medicine and Rehabilitation, Ankara University Faculty of Medicine, Ankara, Turkey.

Interleukin 6 (IL-6) plays a main role in the immunopathogenesis of rheumatoid arthritis (RA). Tocilizumab (TCZ) is a humanized immunoglobulin G1 monoclonal antibody against the human IL-6. Warfarin sodium is an oral anticoagulant that is primarily metabolized by cytochrome P450 2C9 (CYP2C9). Read More

Curr Opin Infect Dis 2021 Jun;34(3):228-237

Section of Infectious Diseases, UT Health McGovern Medical School, Houston, Texas, USA.

Purpose Of Review: Early diagnosis of central nervous system (CNS) infections is crucial given high morbidity and mortality. Neuroimaging in CNS infections is widely used to aid in the diagnosis, treatment and to assess the response to antibiotic and neurosurgical interventions.

Recent Findings: The Infectious Diseases Society of America (IDSA) guidelines have clear recommendations for obtaining a computerized tomography of the head (CTH) prior to lumbar puncture (LP) in suspected meningitis. Read More

Open Forum Infect Dis 2021 Mar 16;8(3):ofab071. Epub 2021 Feb 16.

Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Cefazolin is commonly used as an alternative to antistaphylococcal penicillins (ASPs) in treating methicillin-susceptible (MSSA) infections; however, no study has compared these agents in MSSA spinal epidural abscess (SEA). We describe our experience in managing MSSA SEA and compare the clinical efficacy of cefazolin with ASPs. This retrospective multicenter study reviewed 79 adult patients diagnosed with SEA between January 2006 and July 2020 using data collected from electronic health records and clinical microbiology laboratory databases. Read More