Simultaneous multi-level acute spinal cord compression and acute cauda equina syndrome from an extensive spinal epidural abscess
EANS Academy. Nweze K. 09/25/19; 275365; EP02114
Mr. King-David Nweze
Mr. King-David Nweze

Access to this content is reserved for EANS members and attendees of this event. Click here to become an EANS member and gain your access to the full content of the EANS Academy

Discussion Forum (0)
Rate & Comment (0)
Introduction: Spinal epidural abscess (SEA) is a rare condition, accounting for about 0.2-2.0/10,000 of hospital admissions. However, its accompanying complications are severe and mainly associated with delays in establishing a diagnosis. We present an interesting case of extensive multi-level spinal epidural abscess with simultaneous acute spinal cord compression and acute cauda equina syndrome.
Case presentation: A 50-year old male presented with lower back pain, faecal incontinence, urinary retention, and walking difficulties which were present for a week. He was septic with raised C-reactive protein (CRP) levels and bilateral arm ulcers with Staphylococcus aureus growth, due to intravenous drug usage. There were no movements in his lower limbs with complete loss of sensation below the T10 dermatome. An emergency MRI scan confirmed an epidural abscess extending from C7 down to S1. A posterior lumbar decompression surgery (L3 to S1) was performed first, followed by posterior thoracic decompression (T6 to T9) with approximately 500ml of pus drained. Post-operatively, the patient showed significant neurological improvements in their lower limbs to independent ambulatory status.
Conclusion: Simultaneous multi-level acute spinal cord compression and acute cauda equine syndrome is a rare presentation. Maintaining high suspicion is essential in establishing an early diagnosis of SEA in intravenous drug users. Prompt imaging and emergency decompression increases the likelihood of improved neurological outcomes. We recommend cauda equina decompression considered first followed by spinal cord decompression, with Trendelenburg positioning to promote gravity assisted pus drainage and an infant feeding tube for releasing proximo-distal abscess loculations.
Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.

Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.

Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.

Save Settings