Acta Scientific Neurology (ASNE) (ISSN: 2582-1121)

Case Report Volume 5 Issue 4

Spontaneous Spinal Epidural and Subdural Empyema Causing Cauda Equina Syndrome: A Rare Case Report and Review of Literature

Uchenna Ajoku1* and Mohammad Zarrabian2

1Winnipeg Spine Program, Health Sciences Centre, University of Manitoba, Winnipeg, Canada
2Section of Orthopaedic Surgery, University of Manitoba, Winnipeg, Canada

*Corresponding Author:Uchenna Ajoku, Winnipeg Spine Program, Health Sciences Centre, University of Manitoba, Winnipeg, Canada.

Received: January 31, 2022; Published: March 25, 2022

Abstract

Background Context: Paraspinal abscesses can spread across the various tissue planes and cause neural compression. It appears that if left untreated, infections can spread from the peri-spinal space to the epidural and subdural or vice versa with catastrophic neurologic sequalae. Cauda equina compression is one of such outcomes. This syndrome presents as low back pain, motor and sensory deficits in the lower extremities, and sphincter dysfunction. Potential septic meningitis via disseminated CSF spread may also occur.

Purpose: To report a case of extensive spine infection involving the facet joints, surrounding soft tissues, extra-dural space as well as the intra-dural compartment causing cauda equina syndrome and to review the literature of this scenario.

Study Design/Setting: Case report and review of the literature.

Methods:We reviewed the literature regarding spinal extra-dural and intra-dural infections causing cauda equina syndrome, in terms of possible aetiology, patho-mechanisms and management options.

Results: A 58-year-old woman, with a 1-week history of fever, back pain and left lower extremity weakness as well saddle anaesthesia and sphincteric dysfunction. She is diabetic and hypertensive and had had left hip ORIF and dental surgery 2 years prior. She also had a history of MRSA septicaemia in the last 2 years.
Her history and exam findings were consistent with cauda equina syndrome. Her MRI scan showed L4/5 septic arthritis, extensive paraspinal as well as epidural abscess with marked canal compromise extending from L4 to S1. The patient underwent a debridement, L3-S1 laminectomies, durotomy and drainage of the abscess. Intra-operative cultures were positive for MSSA.

Conclusions:Spread of infection from the paraspinal to the extradural and intradural space causing cauda equina syndrome is extremely rare. Prompt diagnosis, surgical intervention drainage and antimicrobial therapy in conjunction with infectious disease experts is required for the best possible outcome.

Keywords: Spinal Subdural Empyema; Cauda Equina Syndrome; Magnetic Resonance Imaging Septicaemia

References

  1. Kulkarni AG., et al. “Pyogenic intradural abscess: a case report”. Spine (Phila Pa 1976)12 (2007): E354-357.
  2. Vural M., et al. “Spinal subdural Staphylococcus aureus abscess: case report and review of the literature”. Acta Neurologica Scandinavica 5 (2005): 343-346.
  3. Herkowitz HN., et al. “Philadelphia: Saunders Elsevier”. Philadelphia, PA: Saunders Elsevier. The spine. In (2011).
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  8. Nadkarni T., et al. “An intradural-extramedullary gas-forming spinal abscess in a patient with diabetes mellitus”. Journal of Clinical Neuroscience 2 (2010): 263-265.
  9. Ramos AD., et al. “Spinal Subdural Abscess Following Laminectomy for Symptomatic Stenosis: A Report of 2 Cases and Review of the Literature”. American Journal of Case Reports 17 (2016): 476-483.
  10. Lim HY., et al. “Chronic spinal subdural abscess mimicking an intradural-extramedullary tumor”. European Spine Journal 3 (2013): S497-S500.
  11. Ngwenya LB., et al. “Concomitant epidural and subdural spinal abscess: a case report”. Spine Journal 4 (2016): e275-282.

Citation

Citation: Uchenna Ajoku and Mohammad Zarrabian. “Spontaneous Spinal Epidural and Subdural Empyema Causing Cauda Equina Syndrome: A Rare Case Report and Review of Literature". Acta Scientific Neurology 5.4 (2022): 02-06.

Copyright

Copyright: © 2022 Uchenna Ajoku and Mohammad Zarrabian. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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