Answer
Spinal epidural abscess: An area of fluid of approximately 6.5 X 1-cm has collected in the posterior epidural space extending from thoracic vertebrae T4 through T7. Enhancement of the paraspinal muscles is consistent with epidural abscess. Findings include cord compression secondary to epidural abscess, which may result from several causes: hematogenous spread from a distant focus; discitis and/or osteomyelitis extending into the epidural space; or direct extension of an infection from a decubitus ulcer, an infected abdominal wound, or a psoas abscess. The most common location for an epidural abscess is the posterior midthoracic region in thoracic vertebrae T4 through T8. The anterior epidural space is only a potential space because the dura virtually adheres to the posterior surface of the vertebral bodies. Plain-film radiographic findings are usually normal unless concomitant osteomyelitis is present. MRI is the imaging study of choice. The mainstay of treatment is surgical decompression and antimicrobial, steroid, and analgesic therapy.
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BACKGROUND
A 34-year-old African American woman presents to the emergency department with a 1-day history of lower-back pain, bilateral lower-extremity weakness, and an inability to walk. Her symptoms began with numbness and weakness in her right leg; however, the symptoms progressed quickly to the left leg. The woman has a history of hepatitis C. She has no history of back trauma.
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Hint
Physical examination reveals Babinski signs bilaterally.
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Author:
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N. Shaikh, MD, and S. Singh, MD
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Mercy Catholic Medical Center- Mercy Fitzgerald Hospital
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Associate Editor:
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Joanne Connaughton, MD
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Mercy Catholic Medical Center- Mercy Fitzgerald Hospital
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eMedicine Editor:
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Sat Sharma, MD
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Associate Professor, University of Manitoba, Department of Medicine, Division of Pulmonary Medicine
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eMedicine
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