Evaluation of Patients with Spontaneous Spinal Epidural Abscess

Abstract

Purpose: Spontaneous spinal epidural abscess (SSEA) is a rare condition. It generally affects diabetics, immunosuppressed patients, intravenous drug users, and patients with recurrent skin infections or abscesses. If untreated, mortality and morbidity rates are considerably high. The most appropriate treatment is controversial. The classical triad of SSEA consists of pain, fever, and neurological deficits. In our clinical practice, we observed that people with no underlying predisposing factors could also have SSEA, and these patients can apply to the hospital with symptoms such as weight loss, loss of appetite, and general condition disorder as well, apart from the classical triad. The aim of our study is to determine the symptoms other than the classical triad and to contribute to the early diagnosis Materials and Methods: The files of the patients who applied to our tertiary neurosurgery outpatient clinic between January 2015 and December 2018 were scanned, and patients with SSEA were determined. Demographic data of patients, presence of any additional disease, complaints at hospital admission, the time between the onset of the symptoms and diagnosis, magnetic resonance imaging findings, laboratory test results, and prognoses were noted. Results: SSEA was seen in 6 (34/100000) of the patients who applied to our outpatient clinic. The mean age was 54.67±17.06 years. 66.6% (n=4) of them were male. Patients most frequently applied with pain (66.6%), weight loss (50%), and general condition disorder (50%) symptoms. Mortality developed in 33% of the patients, while 66% of the patients recovered completely. Conclusion: The absence of the classical triad in patients with SSEA delayed diagnosis and treatment of patients. If untreated, the disease can be fatal. Early diagnosis and treatment will reduce mortality and morbidity rates.

Keywords

• epidural abscess
• central nervous system infections
• spinal abscess

Spontan Spinal Epidural Apse Saptanan Hastaların Değerlendirilmesi

Abstract

Amaç: Spontan spinal epidural apse (SSEA) nadir görülen bir durumdur. Genellikte diyabetik, immünsupresif hastalarda ve intravenöz (İV) madde bağımlılığı olanlarda, tekrarlayan cilt enfeksiyonu ve apsesi olanlarda görülür. Tedavi edilmediği taktirde mortalite ve morbiditesi oldukça yüksektir. En uygun tedavi şekli tartışmalıdır. Klasik triadı ağrı, ateş ve kuvvet kaybıdır. Klinik pratikte altta yatan hiçbir predispozan faktörü olmayan kişilerde de SSEA olabildiğini ve bu hastaların klasik triadı dışında kilo kaybı, iştahsızlık, genel durum bozukluğu gibi semptomlarla da hastaneye başvurabildiğini gördük. Çalışmamızda amaç klasik triad dışındaki başvuru semptomlarını belirlemek ve erken tanıya katkı sağlayabilmektir. Araçlar ve Yöntem: Üçüncü basamak beyin ve sinir cerrahisi polikliniğine Ocak 2015 ve Aralık 2018 tarihleri arasında başvuran hastaların dosyaları retrospektif olarak tarandı. SSEA’si olan hastalar bulundu. Hastaların yaş, cinsiyet gibi demografik verileri; herhangi bir ek hastalığının olup olmadığı, hastaneye başvuru şikayetleri, şikayetlerin başlamasıyla tanı konması arasında geçen süre, manyetik rezonans görüntüleme bulguları, laboratuvar test sonuçları ve prognozları not edildi. Bulgular: Polikliniğimize başvuran hastaların 6’sında(34/100000) SSEA görüldü. Yaş ortalaması 54.67±17.06 idi. %66.6’sı (n=4) erkekti. Hastaların en sık ağrı (%66.6), kilo kaybı (%50), genel durum bozukluğu (%50) semptomlarıyla başvurduğu görüldü. Hastaların %33’ünde mortalite gelişirken %66’sı tamamen iyileşti. Sonuç: SSEA tanısı konulan hastalarda klasik triadın olmaması hastalarda tanı ve tedaviyi geciktirmiştir. Tedavi edilmeyen hastalarda hastalık ölümcül olabilir. Erken tanı ve tedavisi mortalite ve morbidite oranlarını azaltacaktır.

Keywords

• Epidural apse
• Santral sinir sistemi enfeksiyonları
• spinal apse

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