Spinal Epidural Abscess - Illness Script
Epidemiology:
- Patients at risk for bacteremia: IVDU, dental abscess, HD catheter, endocarditis, epidural catheter placement
- Other risk factors: Alcoholism, DM, HIV
Microbiology:
- Staph aureus most common (63%)
Clinical features:
- Classic, but rare triad: Fever, spinal pain, neuro deficits
- Classic progression: Focal severe back pain -5 radiculopathy motor weakness, sensory changes, and bladder/ bowel dysfunction paralysis
Diagnosis:
- MRI with contrast
- Locate the source: blood cultures (positive 62%), thorough H&P, other imaging as needed
Treatment:
- Surgical drainage
- Antibiotics
Prognosis:
- 5% mortality
- Significant numbers have residual neurological deficits including paraplegia
SCVMC Internal Medicine @SCVMCMed
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