Definition
Definition
Extradural spinal cord abscess, called also epiduritis acute, corresponds to a mass of pus located in space extradural, that is to say epidural and more rarely under the dura mater of the spinal cord, generally in the middle of the dorsal region. It is the result of an infection most often by:
- Un staphylococcus Golden.
- E. coli.
- A germ anaerobic (not requiring oxygen to reproduce).
Anatomy
La dura mater is one of the three brain covering and protecting the central nervous system (brain, spinal cord). This is the outermost of the envelopes constituting the meninges.
Symptoms
Symptoms
Extradural abscess causes the following symptoms:
- Appearance of radicular type pain, that is to say which could pass for a sciatica, or a cruralgia for example.
- A eruption resembling an infection by a herpes, but whose localization is done as a area among others.
Medical exam
Physical examination
If the abscess is large enough, it can cause compression of the spinal cord, which sometimes results in a phenomenon of paraplegia (paralysis of the upper or lower limbs). Sometimes it leads to a anesthesia above the compression, and dysfunction of the sphincters (disturbed emission of urine, defecation disturbed).
The occurrence of a syndrome Cold is possible when there is a blockage. The latter, also called syndrome Lépine Froi is a hyperalbunosis (excess albumin), with a xanthochromia (yellow coloring) of the liquid cerebrospinal. During this condition or disease, the fluid cerebrospinal has another particularity, it sometimes coagulates spontaneously at the time of the lumbar puncture.
La maneuver de Queckenste also called test of Queckenstedt-Stookey, was developed by the German Hans Queckenstedt in 1916. Called in English Queckenstedt stookey test, it is a test which consists of increasing the pressure of the liquid cerebrospinal by compressing the jugulars which are veins that pass on each side of the neck (laterally). The pressure changes will be transmitted from the liquid cerebrospinal, along the canal arachnoid.
L'arachnoid is one of the three meninges located between the spinal cord, adhering to the central nervous system, And the dura mater the most peripheral meninge. It is truly a space of freedom enveloping the central nervous system, and allowing it to protect itself by a shock absorption effect, among other things, and protection against infections. Inside the arachnoid circulates liquid cerebrospinal. If there is no real communication between space arachnoid and venous circulation, the pressures are nevertheless related. Therefore, a change in pressure in the venous system causes an impact in the systems arachnoid. This is why the compression of the jugulars causes the pressure variations which are transmitted to the liquid. cerebrospinal, along the canal arachnoid, when there is no obstacle. Thanks to this test, it is possible to highlight any obstacle, such as for example a tumor, or a abscess which compresses the spinal cord. Below this obstacle, there is no increase in pressure.
Labo
Blood tests show an increase in the amount of protein inside the cerebrospinal fluid.
Additional examination
There is a risk in performing a lumbar puncture (sampling of cerebrospinal fluid by puncturing through the spinal column). Indeed, microbes risk spreading inside the arachnoid space.
MRI and CT scans provide major assistance in the diagnostic orientation of this condition.
Cause
Cause
Most often it is the Staphylococcus aureus which is responsible for the occurrence of an extradural and subdural abscess of the spinal cord. It can also be colibacillus, or germs anaerobic.
The germ is spread by hematogenous means, that is, through the bloodstream, from a distant source (starting point of the infection). This could be, for example, a boil or a dental abscess.
More rarely a osteomyelitis, it is an inflammation, that is to say an infection of the bone leading to contamination of the surrounding area, that is to say the tissues located next to the osteomyelitis which gradually become infected, the dura mater being invaded in turn as well.
Less often the cause of the abscess is an injection through the dura mater, as is the case, for example, in the case of infiltration of corticosteroids intended to relieve a joint of the spine (located between two vertebrae, at the level of the spinal column).
Treatment
Treatment
Treatments for an extradural spinal cord abscess include:
- Hospitalize the patient in a specialized department (infectious medicine, internal medicine, specialized medicine in general medicine).
- Administer a antibiotic adapted after making a antibiogram, that is, a test to determine which antibiotic is effective. Most often, they are effective when it comes to acute forms treated early.
- Sometimes it is necessary to perform what is called a laminectomies, which is a surgical procedure to approach the spinal canal and its contents: the spinal cord and the cauda equina corresponding to the gathering of the last nerves located at the lower end of the spinal cord). This operation is also used in:
- The compressive syndromes (narrowing or stenosis of the spinal canal among others).
- Congenital lumbar canal stenosis.
- Herniated disc.
- Orthopedic procedures involving bone fragments. During this procedure, the abscess is drained, followed by drainage and local instillation (injection) of antibiotics.
Related Terms and Articles
See also
- Abscess
- Arthrifluent abscess
- Brodie's abscess
- Caseous abscess
- Brain abscess
- Shirt button abscess
- Tooth abscess
- Metastatic abscess
- Abscess due to congestion
- Subperiosteal abscess
- Breast abscess
- Tuberous abscess
- Urinary abscess
- Velpeau's tuberous abscess
- Peritonsillar phlegmon
- Acute bacterial prostatitis
- Meningeal Syndrome
- Liver
- Laminectomy
- Spinal cord or spinal cord
- Mycosis fungoides
- Myelomeningocele
- Peritoneum
- pharynx
- Lumbar puncture
- lungs
- Breast (abscess)
- Testicle
- Perinephric phlegmon
- anus
- Hyperalbunosis with xanthochromia of the cerebrospinal fluid
- Aseptic abscess syndrome