Spinal epidural abscess …

John E Greenlee MD

Infectious Disorders

Updated 05.08.2024
Released 03.21.1994
Expires For CME 05.08.2027

Spinal epidural abscess

Author: John E Greenlee MD

See Contributor Disclosures

Spinal epidural abscess

In This Article

Quick Link

Introduction

Overview

Spinal epidural abscess represents loculated infection within the fat-filled space that separates the spinal dura and arachnoid. The condition is a neurologic and neurosurgical emergency that, if unrecognized, may cause devastating neurologic injury or death. Because of its infrequent occurrence, the possibility of epidural abscess tends not to be considered in patients presenting with fever and back or neck pain; for this reason, failure to recognize this spinal epidural abscess makes this condition a significant source of litigation for malpractice. In this article, the author reviews the pathogenesis, clinical features, diagnosis, and treatment of this disorder.

Key points

	• Acute spinal epidural abscess characteristically presents with a consistent sequence of clinical symptoms and signs: severe focal pain, often unrelieved by narcotics, followed by radicular pain, followed by signs of spinal cord compression.
	• Chronic epidural abscesses may exhibit a similar sequence of symptoms and signs, but these may develop slowly over time. The most common presentation of chronic epidural abscess is that of a compressive lesion, sometimes with minimal, if any, pain.
	• Cervical or thoracic spinal epidural abscess may occur as a complication of SARS-CoV-2 infection, including in patients with mild disease.
	• Treatment of spinal epidural abscess, in most cases, involves both antibiotic treatment and surgical drainage. Delay in diagnosis and treatment may result in death or profound, irreversible neurologic impairment.

Historical note and terminology

The first report of spinal epidural abscess is credited to Albers (27). Ducheck termed the condition "peripachymeningitis" in 1853, a name changed by later reports to "pachymeningitis externa." In 1926, Dandy provided the first thorough review of the condition and its pathogenesis, including the observation that usually invasive organisms, such as Staphylococcus aureus, could produce extremely protracted infections within the spinal epidural space (27). In 1948, Heusner delineated the clinical features of spinal epidural abscess in a classical and still valid report (49).

Initially, diagnosis of spinal epidural abscess was based on neurologic localization alone, and treatment was purely surgical. Myelography provided the first means of localizing spinal epidural abscesses with some precision, with CT offering an additional diagnostic tool. MRI, with its ability to visualize the cord over its entire length, has replaced both myelography and CT as the diagnostic method of choice (34; 122). For the most part, spinal epidural abscess remains a surgical condition. In some patients, however, CT-guided needle aspiration has been used in place of surgery, and the ability to monitor an abscess with serial MRI examinations has made it possible to treat selected patients with small epidural abscesses using antibiotics alone (69; 46; 84; 43; 88; 113; 118; 89). Guidelines for the use of CT-guided aspiration and nonsurgical therapy, however, are still being developed (123; 78; 97; 88; 118; 89). Several cases of spinal epidural abscess have been reported in patients with SARS-CoV-2 (COVID-19) infection, making this an important–although infrequent–consideration in patients with COVID-19 infection and spinal cord symptoms (114; 42; 79).

Clinical manifestations

Presentation and course

Spinal epidural abscesses may be acute or chronic. Most patients with acute spinal epidural abscess present within 1 to 3 weeks of onset (30; 29; 97; 113; 118; 21). The initial symptom is characteristically localized, severe pain; this is followed by radicular pain and then by signs of spinal cord compression including impairment of position and vibration sense, the appearance of corticospinal tract findings, the development of a sensory level to vibration, position, light touch, or pinprick, and finally impairment of bowel and bladder control (49; 30; 83; 90; 29). Nuchal rigidity may be present, in particular, in cases of cervical epidural abscess (50). Epidural abscess may occasionally present with abdominal pain, suggesting appendicitis (17; 40). Cases in which infection involves the high cervical epidural space or extends to involve the clivus may present with cranial nerve palsies (12; 111), and a case has been reported in which a cervical epidural abscess presented as cluster headache (74). Mental status may be impaired (13; 30; 83; 90). Older patients (> 65 years of age) may present later in their clinical course and are less apt to have fever but may present with delirium or hypotension (07).

In chronic epidural abscess, the onset of symptoms may be extremely insidious, and the history may suggest an extrinsic spinal cord neoplasm (27; 49; 83). Duration of symptoms in such cases may be 5 months or longer (83). Fever, leukocytosis, and other signs of systemic infection are common but not invariable in acute spinal epidural abscess (55). Fever and leukocytosis are often absent if the infection is chronic and may also be absent in immunosuppressed patients (19; 107; 55; 115).

Prognosis and complications

Mortality in spinal epidural abscess in most current series has been 6% to 15% (90; 29; 97; 118; 21). A study by Du and colleagues recorded a 30-day mean mortality of 3.7%, but a range from 0.3% to 37.5% based on the number of adverse risk factors (36). Adverse outcome tends to be significantly higher in cervical epidural abscess than in epidural abscesses involving thoracic or lumbar spine (43). Prognosis for neurologic recovery worsens in direct proportion to the degree of neurologic deficit and correlates both with the length of the abscess and the degree of cord compression (117; 90). Prognosis is excellent in epidural abscess if treatment is given before signs of cord compression occur (30; 83; 62; 32; 29; 97; 43). Conversely, however, prognosis is guarded if signs of cord compression are already present, and full recovery is much less likely if the duration of paralysis is greater than 24 hours. Likelihood of poor outcome is worse in diabetics and the elderly and may be worse in cases associated with methicillin-resistant Staphylococcus aureus (MRSA) than with methicillin-sensitive strains (52; 07; 118). Adverse factors in patients treated with antibiotics alone include age over 65 years and diabetes, MRSA infection, and the presence of neurologic deficits (64; 07). Patients acquiring epidural abscess following intravenous drug abuse, which is a risk factor that accounts for 19% of spinal epidural abscesses, can be particularly challenging because of patient compliance (127; 02). In their analysis of 30-day mortality, Du and colleagues listed adverse risk factors of older age, diabetes, hypertension, respiratory comorbidities, renal comorbidities, metastatic cancer, and thrombocytopenia (36).

Clinical vignette

A 57-year-old man was in his usual state of health until 20 days prior to his admission when he stooped to move a heater. He felt a twinge of soreness in his upper back and because of this took a hot shower and went to bed. He awoke 2 hours later with profuse sweating and back pain so severe that he had difficulty breathing. He treated the pain initially with ibuprofen. The back pain continued, however, and the patient developed circumferential abdominal pain, which he described as "pulling from the spine and shoulders downward." Treatment with ice, heat, and analgesics was unhelpful. The patient noted that his legs were becoming progressively weaker and number, forcing him to use a cane to ambulate. He was unable to move his bowels and was able to urinate only by manually compressing his abdomen. Six days prior to admission the patient was seen at another facility, where lumbar CT was negative and where he received cephalexin, a muscle relaxant, and codeine. These medications relieved the patient’s pain, but he became unable to ambulate 5 days prior to admission. At the time of his admission he had been unable to walk for 5 days and had not had a bowel movement for 20 days.

His past health was noncontributory. The patient’s mother had diabetes, but the patient had never been diagnosed as diabetic. The patient was divorced and had been homeless before coming to his present situation, which involved working as an assistant dog groomer in exchange for room and board. The patient consumed one fifth of vodka per week but denied intravenous drug abuse, homosexual activity, or contact with prostitutes.

On examination the patient was acutely ill. Pulse was 64 per minute, blood pressure 123/73, respirations 24, and temperature 95.9°F. General physical examination was essentially normal without focal back pain but with nuchal rigidity. The patient was alert and oriented. Cranial nerves were normal. Motor examination revealed mild left arm weakness and unequivocal bilateral lower extremity weakness. Light touch was intact, but the patient had diminished pinprick sensation to the lower abdomen and absent vibration sensation to the costal margin. Station and gait could not be tested. Reflexes were not increased, but Babinski sign was present bilaterally. Hematocrit was 36 and white blood cell count was 18,000. Erythrocyte sedimentation rate was 57 mm per hour. MRI showed an enhancing mass lesion posterior to the cord, extending from C7 to T12, consistent with an epidural abscess.

Spinal epidural abscess

Gadolinium-enhanced MRI of a 57-year-old male patient. There is a large, loculated abscess posterior to the cord with severe spinal cord compression. The abscess extends from C7 to T12. (Contributed by Dr. John Greenlee.)

The patient was placed on cefotaxime, vancomycin, and metronidazole and underwent emergency C7, T1, T11, and T12 laminectomy and drainage, with catheter-directed lavage of the epidural space. Cultures of the abscess grew Streptococcus pneumoniae, sensitive to penicillin. Blood cultures were negative. The patient was initially treated with penicillin and then, to allow less frequent dosing, with cefuroxime, totaling 8 weeks of intravenous antibiotic therapy. The patient regained bladder control with a gradual and partial return of his lower extremity function.

Biological basis

Etiology and pathogenesis

Etiology. Spinal epidural abscess due to Streptococcus pneumonia, as illustrated in the above case, is unusual (100). The major organism associated with spinal epidural abscess is Staphylococcus aureus; this organism is isolated in 50% to 90% of cases of acute epidural abscess and may also, somewhat surprisingly, be found in chronic abscesses (27; 13; 58; 30; 83; 72; 92; 90; 61; 29; 43; 08; 85; 102). Up to 40% of Staphylococcus aureus isolates from epidural abscesses may be methicillin-resistant strains (29; 24; 08). Aerobic and facultative streptococci may be found in 5% to 10% of cases (13; 67; 83; 92; 08; 85; 102). Gram-negative aerobic and anaerobic organisms, including Escherichia coli, Proteus, Pseudomonas aeruginosa, and Bacteroides fragilis occur in 8% to 17% of cases (13; 30; 08). Staphylococcus epidermidis is most commonly found in cases associated with neurosurgical procedures (30). Spinal epidural abscess in the postpartum period may be associated with group B streptococci (54). Mycobacterium tuberculosis may be associated with chronic epidural abscess and is of particular concern in patients with AIDS or with a history of intravenous drug abuse (58; 66; 68; 45). Tuberculous epidural abscess may also occur as the sole sign of reactivated tuberculosis (58). In rare instances, epidural abscess has been associated with Streptococcus pneumoniae during bacterial endocarditis (23). Occasional cases have been caused by Neisseria gonorrhoeae (75), Group G streptococci (94), Listeria monocytogenes (03), Nocardia asteroides (09), Echinococcus (58), Brucella (109; 44), Candida albicans and Aspergillus (125). Melioidosis may be an occasional cause of epidural abscess in developing countries (81). Multiple organisms are found in approximately 10% of patients (13; 30; 83). A mixed flora of Staphylococcus aureus and Cryptococcus neoformans has been reported in a patient with AIDS (87), and epidural abscess may rarely be caused by Blastomyces dermatitidis (14). Spinal epidural abscess in children is also most commonly associated with Staphylococcus aureus but has been associated with group B streptococcus in a pediatric patient with chronic vesicoureteral reflux (10). Bartonella henselae, the agent of cat scratch fever, has been isolated from the epidural abscess of a 5-year-old child (35).

In 2012 multiple cases of epidural abscess, meningitis, and central nervous system vasculitis due to unusual agents were reported in patients receiving epidural injections of contaminated methylprednisolone, resulting in 753 cases and 61 deaths (56; 60; 106; 59). Aspergillus fumigatus was isolated in one patient. However, most isolates have been other fungi, either Exserohilum rostratum or Cladosporium species (56; 60; 59). Recurrence of infection following treatment has been described after up to 24 months (91). More recent cases of infection with these agents following contaminated methylprednisolone have not been reported.

Pathogenesis. The spinal canal, unlike the skull, contains a fat-filled epidural space that provides little resistance to the spread of infection. Organisms may enter this space as a complication of bacteremia, by direct spread from vertebral osteomyelitis, by extension of infection from superficial cutaneous infections such as furuncles, or by lymphatic spread from infections within the retropharyngeal space, posterior mediastinum, or retroperitoneal space (13; 30; 29). Secondary cases have long been recognized as a complication of surgery; cases of secondary spinal epidural abscess, however, have become more frequent with the increased use of spinal interventions for pain management (61). The resultant epidural abscess usually occupies one to five vertebral segments and may extend the entire length of the cord. The abscess may be anterior to the cord, posterior to the cord, or circumferential. The narrow diameter of the spinal canal allows epidural abscess to produce spinal cord compression and necrosis while still relatively small, and longitudinal spread of infection in either condition can result in cord necrosis extending over multiple vertebral segments, both from direct cord compression and from vascular compromise; importantly, vascular compromise may cause spinal cord infarction in the absence of radiologically detectable cord compression (20; 13; 41; 120). Infection of the intervertebral disc at one or more levels is present in up to 80% of acute cases (82). Accompanying osteomyelitis can be detected in up to 65% of cases (13; 30; 83; 93).

Differential diagnosis

Spinal epidural abscess is sufficiently rare that the diagnosis is often not considered, yet it is common enough to constitute a real diagnostic consideration and is not an uncommon cause of lawsuits for malpractice (05). This is particularly important for physicians at the point of initial contact, so emergency room and other nonoperative physicians are more likely to be sued than are surgeons (05; 33; 99). The great challenge in epidural abscess is not treatment, which is highly successful if instituted early, but rather prompt diagnosis allowing for appropriate therapy before development of severe neurologic injury (90; 32; 39; 31; 112; 08; 85; 102). Epidural abscess should be suspected in any patient presenting with acute, severe spinal or radicular pain, particularly if there is evidence of active infection or if there is a history of diabetes mellitus, intravenous drug abuse, back trauma (which may be minor), or pregnancy (29; 73; 97; 118; 116). Davis and colleagues have suggested additional risk factors, which include immunosuppressed states, chronic liver or kidney disease, indwelling vascular catheter, recent spinal surgery (especially with indwelling hardware), or known systemic infection (31). Diagnostic accuracy may be significantly increased by use of an algorithm combining presence of these risk factors with clinical presentation and elevation of erythrocyte sedimentation rate (ESR) or C-reactive protein (31). In the study by Davis and colleagues, ESR was elevated to higher than 20 m/hour in all patients with spinal epidural abscess as opposed to 33% of patients with spine pain but without abscess. Of interest, the mean ESR value for 86 patients with spinal epidural abscess was 76.5 mm/hour as opposed to 20.1 mm/hour in patients in whom epidural abscess was not found, indicating that significant elevation of the ESR should increase suspicion that a spinal epidural abscess may be present (31).

As mentioned above, spinal epidural abscess may occasionally present as an acute abdomen (17; 40). Spinal osteomyelitis may duplicate the findings of focal pain but will not by itself produce radicular or long-tract findings. Spinal subdural empyema, which may mimic spinal epidural abscess, is extremely rare. Spinal epidural hemorrhage, rapidly growing spinal epidural tumor or, more rarely, spinal epidural cysts are also diagnostic considerations (51; 71). The absence of fever in a patient presenting with back pain does not exclude the possibility of epidural abscess (55; 73). The possibility of staphylococcal cervical or thoracic epidural abscess should be kept in mind when dealing with patients with SARS-CoV-2 infection who develop radicular pain or signs of spinal cord injury; it is important to keep in mind that the associated COVID-19 infection may not be severe and that epidural abscess can develop in patients who do not require intubation (108; 114; 42).

Diagnostic workup

MRI is the procedure of choice because of its ability to visualize the cord over its entire length (30; 82; 92; 117; 90; 84; 29; 97; 122). It can also indicate the site of origin of an epidural abscess. Both acute epidural abscess and adjacent osteomyelitis may exhibit increased signal on diffusion-weighted imaging and be dark on ADC maps (38; 80). (Myelography supplemented by CT scan should be used if MRI is not available.) Myelography carries some risk of introducing the offending organism into the subarachnoid space and causing meningitis. For this reason, the spinal puncture should be conducted at a level distant from that believed to be occupied by the abscess or empyema. Thus, a lateral cervical puncture should be used if lumbar infection is suspected, and a lumbar approach should be used if the cervical or high thoracic spine is involved. Plain radiography may be useful in cases of suspected discitis and vertebral osteomyelitis. Blood and material from infected sites should be cultured for aerobic and anaerobic organisms. Blood cultures can be expected to be positive in approximately 50% of acute cases (30). Infection of spinal fluid is unusual (30).

Thoracic vertebral osteomyelitis with epidural abscess (MRI)

Changes are seen in the affected vertebrae and interspaces. The spinal cord is surrounded by the hyperintense pus.
Myelogram of spinal epidural abscess (CT)

The large dorsal collection of hypodense pus and necrotic fat narrows the contrast-filled dural sac.
Vertebral osteomyelitis (plain radiograph)

The disc space is narrowed; the endplates of the vertebral bodies are sclerotic and indistinct. Additional vertebral body sclerosis and bony spurring suggests this is a chronic process.

Management

In almost all cases, spinal epidural abscess is an absolute indication for urgent open surgery or, in selected cases, microsurgery or CT-guided aspiration (90; 78; 15; 43; 24; 37; 88; 118; 96). Occasional spinal epidural abscesses may be treated with antibiotics alone if the abscess is small and the patient is neurologically completely normal. Ideally, in such patients, CT-guided biopsy should be used to identify the causative organism (69; 46; 123; 68; 97; 118). Rarely, more extensive spinal epidural abscesses have been treated successfully with antibiotics alone, but this approach remains the exception in larger abscesses (119). Outcome of patients treated with antibiotics alone, as compared to those treated surgically as well, has varied from series to series, and the two approaches have not been subjected to controlled trial (103; 26; 86; 88; 110). In one series, however, 41% of patients treated initially with antibiotics alone required subsequent surgical drainage (85). Thus, it must be kept in mind that not all patients respond to antibiotic therapy alone and that epidural abscess may fail to resolve and may actually progress in the face of antibiotic treatment (123; 06; 08). For this reason, patients treated with antibiotics alone are at potentially higher risk and, thus, require meticulous clinical observation and frequent neuroradiological follow-up (113; 98). Progression of neurologic signs in the face of antibiotic therapy alone is an absolute indication for surgical intervention. Predictors of a poor response to antibiotic therapy alone include patient age greater than 65 years, patients with diabetes mellitus, infection due to methicillin-resistant Staphylococcus aureus (MRSA), and patients manifesting neurologic deficits (64; 07). Shah and colleagues evaluated the occurrence of treatment failure in patients with spinal epidural abscess whose initial treatment was nonoperative (98). Of 367 patients, 99 treatment failures occurred. Independent predictors of failure included motor deficit at presentation; sensory changes; diabetes mellitus; pathologic or compression fracture in affected levels; active malignancy, and dorsal location of abscess. Laboratory values suggesting that medical management may be unsuccessful include C-reactive protein greater than 115 and white blood count greater than 12,500 (85). Hunter and colleagues have reviewed post-treatment fall in C-reactive protein as a prognostic indicator and have found that failure to reduce C-reactive protein by 50% by day 4 to 5 after initiation of treatment was associated with longer hospital stay, worse functional outcome, and greater mortality risk within 2 years, suggesting that failure of C-reactive protein to fall within 4 to 5 days should prompt a search for other foci of infection or consider modification of treatment regimen (53). It must also be kept in mind that spinal cord injury in epidural abscess may be due to vasculitis and may occur before severe spinal cord compression is detected.

Initial antibiotic therapy where the causative agent is unknown should be directed against S. aureus and the streptococci and should include vancomycin until sensitivity to oxacillin or nafcillin is determined (92). Vancomycin should be continued if the organism is found to be methicillin-resistant or there is a history of penicillin allergy. Khatib and colleagues have reported a patient who developed a spinal epidural abscess while receiving vancomycin for a methicillin-resistant Staphylococcus aureus infection. In this case, resolution of infection was achieved with a combination of gentamicin and vancomycin (63). Ceftriaxone or cefotaxime should be added if there is any question of a gram-negative organism. Ceftazidime or meropenem should be used if there is strong evidence for infection with Pseudomonas aeruginosa. These third-generation cephalosporins should be supplemented with systemic gentamicin or amikacin (121). Metronidazole should be used if infection by Bacteroides fragilis is suspected. Aminoglycoside agents such as gentamicin and amikacin cross the blood-brain barrier poorly and for this reason, systemic gentamicin is not used to treat gram-negative meningitis in adults. The spinal epidural space lies outside the blood-brain barrier, however, and although no controlled studies exist to support a role for gentamicin in spinal epidural abscess, consideration should be given to its use in epidural abscess caused by gram-negative organisms. Final selection of antibiotics is based on isolation of organisms from abscess material and determination of antibiotic sensitivity.

Holospinal epidural abscesses represent an area of particular concern, with overall high morbidity. Treatment always involves surgery and often extensive laminectomy. In a study of eight patients who underwent holospinal epidural abscesses, patients received an average of 8.6 laminectomies--one requiring laminectomy of the entire spinal column, three skip laminectomies, and three additional surgeries (18). In this series, 50% of the treated patients improved, 37.5% remained neurologically unchanged, and 12.5% worsened.

Treatment of spinal epidural abscess and of other complications arising from epidural injections of contaminated methylprednisolone has not been subjected to controlled trials. Initially, treatment involved voriconazole, and in some patients, voriconazole was used in combination with liposomal amphotericin B (56; 60). Subsequently, this combined therapy was used only in the most ill patients, most other patients undergoing voriconazole monotherapy for 6 months or longer (59). Delayed recurrence of epidural infection has been reported in one patient treated over time with both voriconazole and liposomal amphotericin B (91).

Media

References

01: Abdelrahman H, Shousha M, Bahrami R, Boehm H. Haematogenous spondylodiscitis in patients with liver cirrhosis: case series of 36 patients. Spine (Phila Pa 1976) 2020;45(8):E425-9. PMID 31770341
02: Acheson LS, Siefried KJ, Clifford B, et al. One-third of people who inject drugs are at risk of incomplete treatment for Staphylococcus aureus bacteraemia: a retrospective medical record review. Int J Infect Dis 2021;112:63-5. PMID 34520844
03: Adebolu OI, Sommer J, Idowu AB, Lao N, Riaz T. Vertebral osteomyelitis and epidural abscess due to Listeria monocytogenes - case report and review of literature. J Bone Jt Infect 2022;7(2):75-9. PMID 35464149
04: Aguilar-Shea AL, Molino-Gonzalez AM, Gallardo-Mayo C, Pedradas-Navas JM. Is prostatic biopsy as safe as we think. Epidural abscess following prostatic biopsy. Can J Urol 2008;15:4186-90. PMID 18706150
05: Alerhand S, Wood S, Long B, Koyfman A. The time-sensitive challenge of diagnosing spinal epidural abscess in the emergency department. Intern Emerg Med 2017;12(8):1179-83. PMID 28779448
06: Alton TB, Patel AR, Bransford RJ, Bellabarba C, Lee MJ, Chapman JR. Is there a difference in neurologic outcome in medical versus early operative management of cervical epidural abscesses? Spine J 2015;15(1):10-7. PMID 24937797
07: Amadoru S, Lim K, Tacey M, Aboltins C. Spinal infections in older people an analysis of demographics, presenting features, microbiology and outcomes. Intern Med J 2017;47(2):182-8. PMID 27753184
08: Arko L 4th, Quach E, Nguyen V, Chang D, Sukul V, Kim BS. Medical and surgical management of spinal epidural abscess: a systematic review. Neurosurg Focus 2014;37(2):E4. PMID 25081964
09: Atalay B, Azap O, Cekinmez M, Caner H, Haberal M. Nocardial epidural abscess of the thoracic spinal cord and review of the literature. J Infect Chemother 2005;11:169-71. PMID 15990983
10: Auletta JJ, John CC. Spinal epidural abscesses in children: a 15-year experience and review of the literature. Clin Infect Dis 2001;32:9-16. PMID 11112668
11: Avila JD, Zivkovic S. Spinal epidural abscess following treatment with rituximab. Acta Neurol Scand 2016;133(5):403-5. PMID 26392320
12: Azizi SA, Fayad PB, Fulbright R, Giroux ML, Waxman SG. Clivus and cervical spinal osteomyelitis with epidural abscess presenting with multiple cranial neuropathies. Clin Neurol Neurosurg 1995;97:239-44. PMID 7586856
13: Baker AS, Oemann RG, Swartz MN, Richardson EP Jr. Spinal epidural abscess. N Engl J Med 1975;293:463-8. PMID 1152860
14: Bariola JR, Perry P, Pappas PG, et al. Blastomycosis of the central nervous system: a multicenter review of diagnosis and treatment in the modern era. Clin Infect Dis 2010;50(6):797-804. PMID 20166817
15: Bostrom A, Oertel M, Ryang Y, et al. Treatment strategies and outcome in patients with non-tuberculous spinal epidural abscess - a review of 46 cases. Minim Invasive Neurosurg 2008;51:36-42. PMID 18306130
16: Boulis NM, Armstrong WS, Chandler WF, Orringer MB. Epidural abscess: a delayed complication of esophageal stenting for benign stricture. Ann Thorac Surg 1999;68:568-70. PMID 10475435
17: Bremer AA, Darouiche RO. Spinal epidural abscess presenting as intra-abdominal pathology: a case report and literature review. J Emerg Med 2004;26(1):51-6. PMID 14751478
18: Bridges KJ, Than KD. Holospinal epidural abscesses - Institutional experience. J Clin Neurosci 2018;48:18-27. PMID 29113855
19: Broner FA, Garland DE, Zigler JE. Spinal infections in the immunocompromised host. Orthop Clin North Am 1996;27:37-46. PMID 8539051
20: Browder J, Meyers R. Pyogenic infections of the spinal epidural space. Surgery 1941;10:296-308.
21: Chen M, Baumann AN, Fraiman ET, Cheng CW, Furey CG. Long-term survivability of surgical and nonsurgical management of spinal epidural abscess. Spine J 2024;24(5):748-58. PMID 38211902
22: Chowfin A, Potti A, Paul A, Carson P. Spinal epidural abscess after tattooing. Clin Infect Dis 1999;29:225-6. PMID 10433605
23: Clark R, Carlisle JT, Valainis GT. Streptococcus pneumoniae endocarditis presenting as an epidural abscess. Rev Infect Dis 1989;11:338-40. PMID 2704929
24: Connor DE Jr, Chittiboina P, Caldito G, Nanda A. Comparison of operative and nonoperative management of spinal epidural abscess: a retrospective review of clinical and laboratory predictors of neurological outcome. J Neurosurg Spine 2013;19(1):119-27. PMID 23662888
25: Cross RK Jr, Howell C. Two cases of spontaneous epidural abscess in patients with cirrhosis. South Med J 2003;96(3):291-3. PMID 12659363
26: Curry WT Jr, Hoh BL, min-Hanjani S, Eskandar EN. Spinal epidural abscess: clinical presentation, management, and outcome. Surg Neurol 2005;63:364-71. PMID 15808726
27: Dandy WE. Abscesses and inflammatory tumors in the spinal epidural space (so-called pachymeningitis externa). Arch Surg 1926;13:477-94.
28: Darabi K, Jaiswal R, Hostetler S, Bechtel M, Zirwas M. Infectious complications in patients with psoriasis and rheumatoid arthritis treated with antitumor necrosis factor agents and methotrexate. J Drugs Dermatol 2009;8:175-8. PMID 19213235
29: Darouiche RO. Spinal epidural abscess. New Engl J Med 2006;355:2012-20. PMID 17093252
30: Darouiche RO, Hamill RJ, Greenberg SB, Weathers SW, Musher DM. Bacterial spinal epidural abscess. Review of 43 cases and literature survey. Medicine 1992;71:369-85. PMID 1359381
31: Davis DP, Salazar A, Chan TC, Vilke GM. Prospective evaluation of a clinical decision guideline to diagnose spinal epidural abscess in patients who present to the emergency department with spine pain. J Neurosurg Spine 2011;14:785-70. PMID 21417700
32: Davis DP, Wold RM, Patel RJ, et al. The clinical presentation and impact of diagnostic delays on emergency department patients with spinal epidural abscess. J Emerg Med 2004;26(3):285-91. PMID 15028325
33: DePasse JM, Ruttiman R, Eltorai AEM, Palumbo MA, Daniels AH. Assessment of malpractice claims due to spinal epidural abscess. J Neurosurg Spine 2017;27(4):476-80. PMID 28498071
34: Dhodapkar MM, Patel T, Rubio DR. Imaging in spinal infections: current status and future directions. N Am Spine Soc J 2023;16:100275. PMID 37822347
35: Dornbos D 3rd, Morin J, Watson JR, Pindrik J. Thoracic osteomyelitis and epidural abscess formation due to cat scratch disease: case report. J Neurosurg Pediatr 2016:1-4. PMID 27662446
36: Du JY, Schell AJ, Kim CY, Trivedi NN, Ahn UM, Ahn NU. 30-Day mortality following surgery for spinal epidural abscess: incidence, risk factors, predictive algorithm, and associated complications. Spine (Phila Pa 1976) 2019;44(8):E500-9. PMID 30234819
37: Duarte RM, Vaccaro AR. Spinal infection: state of the art and management algorithm. Eur Spine J 2013;22(12):2787-99. PMID 23756630
38: Eastwood JD, Vollmer RT, Provenzale JM. Diffusion-weighted imaging in a patient with vertebral and epidural abscesses. AJNR Am J Neuroradiol 2002;23(3):496-8. PMID 11901028
39: El Sayed M, Witting MD. Low yield of ED magnetic resonance imaging for suspected epidural abscess. Am J Emerg Med 2011;29(9):978-82. PMID 20674237
40: Fakhouri F, Ghazal A, Alnaeb H, Hezan R, Araj J. Spinal-epidural abscess presenting as an acute abdomen in a child: a case report and review of the literature. Asian J Neurosurg 2018;13(4):1247-19. PMID 30459907
41: Fukui T, Ichikawa H, Kawate N, Nozawa T, Sugita K. Acute spinal epidural abscess and spinal leptomeningitis: report of 2 cases with comparative neuroradiological and autopsy study. Eur Neurol 1992;32:328-33. PMID 1490500
42: Gennaro N, Bonifacio C, Corato M, Milani D, Politi LS. Quadriparesis caused by retropharyngeal and epidural abscess in COVID-19 patients. Neurol Sci 2021;42(5):1683-5. PMID 33675434
43: Gonzalez-Lopez JJ, Gorgolas M, Muniz J, Lopez-Medrano F, Barnes PR, Fernandez Guerrero ML. Spontaneous epidural abscess: analysis of 15 cases with emphasis on diagnostic and prognostic factors. Eur J Intern Med 2009;20(5):514-7. PMID 19712856
44: Gorgulu ,A, Albayrak BS, Gorgulu E. Spinal epidural abscess due to Brucella. Surg Neurol 2006;66:141. PMID 16876603
45: Gupta RK, Gupta S, Kumar S, Kohli A, Misra UK, Gujral RB. MRI in intraspinal tuberculosis. Neuroradiology 1994;36:39-43. PMID 8107996
46: Hanigan WC, Asner NG, Elwood PW. Magnetic resonance imaging and the nonoperative treatment of spinal epidural abscess. Surg Neurol 1990;34:408-13. PMID 1978763
47: Harston PK. Spinal epidural abscess as a complication of duodenolumbar fistula. A case report. Spine 1992;17:593-6. PMID 1621161
48: Heindel CC, Ferguson JP, Kumarasamy T. Spinal subdural empyema complicating pregnancy. J Neurosurg 1974;40:654-6. PMID 4817812
49: Heusner AP. Nontuberculous spinal epidural infections. N Engl J Med 1948;239:845-54. PMID 18894306
50: Honig A, Or O, Barzilay Y, et al. Spinal epidural abscess with a rapid course in young healthy infantry recruits with multiple skin lacerations. J Clin Neurosci 2016;31:127-32. PMID 27364320
51: Hopkins TJ, Raducan V, Sioutos N, White A. Lumbar lymphoma presenting as psoas abscess/epidural mass with acute cauda equina syndrome. A case report. Spine 1993;18:774-8. PMID 8516712
52: Huang PY, Chen SF, Chang WN, et al. Spinal epidural abscess in adults caused by Staphylococcus aureus: Clinicalcharacteristics and prognostic factors. Clin Neurol Neurosurg 2012;114:572-6. PMID 22206858
53: Hunter S, Ou C, Baker JF. Early reduction in C-reactive protein following treatment for spinal epidural abscess: a potential treatment guide. Global Spine J 2023;21925682221139801. PMID 36802919
54: Jenkin G, Woolley IJ, Brown GV, Richards MJ. Postpartum epidural abscess due to group B Streptococcus. Clin Infect Dis 1997;25:1249. PMID 9402395
55: Joshi SM, Hatfield RH, Martin J, Taylor W. Spinal epidural abscess: a diagnostic challenge. Br J Neurosurg 2003;17:160-3. PMID 12820759
56: Kainer MA, Reagan DR, Nguyen DB. Fungal infections associated with contaminated methylprednisolone in Tennessee. N Engl J Med 2012;367(23):2194-203. PMID 23131029
57: Kaya M, Kosemehmetoglu K, Yildirim CH, et al. Spondylodiscitis as a spinal complication of transrectal ultrasound-guided needle biopsy of the prostate. Spine 2012;37:E870-2. PMID 22472806
58: Kaufman DM, Kaplan JG, Litman N. Infectious agents in spinal epidural abscesses. Neurology 1980;30:844-50. PMID 7191067
59: Kauffman CA, Malani AN. Fungal infections associated with contaminated steroid injections. Microbiol Spectr 2016;4(2). PMID 27227303
60: Kerkering TM, Grifasi ML, Baffoe-Bonnie AW, et al. Early clinical observations in prospectively followed patients with fungal meningitis related to contaminated epidural steroid injections. Ann Intern Med 2013;158(3):154-61. PMID 23183583
61: Khan SH, Hussain MS, Griebel RW, Hattingh S. Comparison of primary and secondary spinal epidural abscesses: a retrospective analysis of 29 cases. Surg Neurol 2003;59:28-33. PMID 12633952
62: Khanna RK, Malik GM, Rock JP, Rosenblum ML. Spinal epidural abscess: evaluation of factors influencing outcome. Neurosurgery 1996;39:958-64. PMID 8905751
63: Khatib R, Riederer KM, Held M, Aljundi H. Protracted and recurrent methicillin-resistant Staphylococcus aureus bacteremia despite defervescence with vancomycin therapy. Scand J Infect Dis 1995;27:529-32. PMID 8588150
64: Kim SD, Melikian R, Ju KL, et al. Independent predictors of failure of nonoperative management of spinal epidural abscesses. Spine J 2014;14(8):1673-9. PMID 24373683
65: Knight JW, Cordingley JJ, Palazzo MG. Epidural abscess following epidural steroid and local anaesthetic. Anaesthesia 1997;52:576-8. PMID 9203886
66: Koppel BS, Tuchman AJ, Mangiardi JR, Daras M, Weitzner I. Epidural spinal infection in intravenous drug abusers. Arch Neurol 1988;45:1331-7. PMID 3058095
67: Krajewski R, Stelmasiak Z. Brain abscess in infants. Childs Nerv Syst 1992;8:279-80. PMID 1394267
68: Latronico N, Tansini A, Gualandi GF, et al. Successful nonoperative treatment of tuberculous spinal epidural abscess with cord compression: the role of magnetic resonance imaging. Eur Neurol 1993;33:177-80. PMID 8467829
69: Leys D, Lesoin F, Viaud C, et al. Decreased morbidity from acute bacterial spinal epidural abscesses using computed tomography and nonsurgical treatment in selected patients. Ann Neurol 1985;17:350-5. PMID 4004156
70: Lee JH, Cho JH, Jo DJ. Cervical epidural abscess after cupping and acupuncture. Complement Ther Med 2012;20(4):228-31. PMID 22579435
71: Lee SW, Foo A, Tan CL, et al. Spinal extradural cyst: case report and review of literature. World Neurosurg 2018;116:343-6. PMID 29870839
72: Liem LK, Rigamonti D, Wolf AL, Robinson WL, Edward CC, DiPatri A. Thoracic epidural abscess. J Spinal Disord 1994;7:449-54. PMID 7819646
73: Liou LM, Shih PY. Epidural abscess of the cervical spine with atypical manifestations: a report of two cases. Neurologist 2007;13:215-8. PMID 17622914
74: Liu KT, Su CS. Cluster-like headache as an opening symptom of cervical spinal epidural abscess. Am J Emerg Med 2009;27(3):370. PMID 19328393
75: Low SY, Ong CW, Hsueh PR, Tambyah PA, Yeo TT. Neisseria gonorrhoeae paravertebral abscess. J Neurosurg Spine 2012;17(1):93-7. PMID 22578237
76: Lowell TD, Errico TJ, Eskenazi MS. Use of epidural steroids after discectomy may predispose to infection. Spine 2000;25:516-9. PMID 10707400
77: Lundy SD, Gill BC, Kalfas IH, Fergany AF, Stephenson AJ. Epidural abscess following prostate biopsy. Urology 2018;113:1-5. PMID 29122622
78: Lyu RK, Chen CJ, Tang LM, Chen ST. Spinal epidural abscess successfully treated with percutaneous, computed tomography-guided, needle aspiration and parenteral antibiotic therapy: case report and review of the literature. Neurosurgery 2002;51(2):509-12; discussion 512. PMID 12182793
79: Mohamed Ramlee FA, Harun MHB, Nagaretnam V, Lim TS, Aris HF, Tan CN. A case series of spinal infections following COVID-19: a delayed complication. Cureus 2022;14(9):e29272. PMID 36277530
80: Moritani T, Kim J, Capizzano AA, Kirby P, Kademian J, Sato Y. Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections. Br J Radiol 2014;87(1041):20140011. PMID 24999081
81: Muthusamy KA, Waran V, Puthucheary SD. Spectra of central nervous system melioidosis. J Clin Neurosci 2007;14:1213-5. PMID 17964168
82: Numaguchi Y, Rigamonti D, Rothman MI, Sato S, Mihara F, Sadato N. Spinal epidural abscess: evaluation with gadolinium-enhanced MR imaging. Radiographics 1993;13:545-59. PMID 8316663
83: Nussbaum ES, Rigamonti D, Standiford H, Numaguchi Y, Wolf AL, Robinson WL. Spinal epidural abscess: a report of 40 cases and review. Surg Neurol 1992;38:225-31. PMID 1359657
84: Parkinson JF, Sekhorn LH. Spinal epidural abscess: appearance on magnetic resonance imaging as a guide to surgical management. Report of five cases. Neurosurg Focus 2004;17:E12. PMID 15636569
85: Patel AR, Alton TB, Bransford RJ, Lee MJ, Bellabarba CB, Chapman JR. Spinal epidural abscesses: risk factors, medical versus surgical management, a retrospective review of 128 cases. Spine J 2014;14(2):326-30.** PMID 24231778
86: Pereira CE, Lynch JC. Spinal epidural abscess: an analysis of 24 cases. Surg Neurol 2005;63 Suppl 1:S26-9. PMID 15629340
87: Pirofski L, Casadevall A. Mixed staphylococcal and cryptococcal epidural abscess in a patient with AIDS. Rev Infect Dis 1990;12:964-5. PMID 2237142
88: Pourtaheri S, Issa K, Stewart T, et al. When do you drain epidural abscesses of the spine? Surg Technol Int 2016;29:374-8. PMID 27608748
89: Ran B, Chen X, Zhong Q, Fu M, Wei J. CT-guided minimally invasive treatment for an extensive spinal epidural abscess: a case report and literature review. Eur Spine J 2018;27(Suppl 3):380-5. PMID 28951964
90: Reihsaus E, Waldbaur H, Seeling W. Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev 2000;23:175-204; discussion 205. PMID 11153548
91: Renfrow JJ, Frenkel MB, Hsu W. Fungal contamination of methylprednisolone causing recurrent lumbosacral intradural abscess. Emerg Infect Dis 2017;23(3):552-3. PMID 27227303
92: Rigamonti D, Liem L, Sampath P, et al. Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol 1999;52:189-96. PMID 10447289
93: Sadato N, Numaguchi U, Rigaminti D, et al. Spinal epidural abscess with gadolinium-enhanced MRI: serial follow-up studies and clinical correlations. Neuroradiology 1994;36:44-8. PMID 8107997
94: Saeed MU, Gottmukkula R, Kennedy DJ. Group G Streptococcus spinal epidural abscess: case report and review of the literature. Scand J Infect Dis 2007;39(11-12):1073-5. PMID 17852916
95: Sarubbi FA, Vasquez JE. Spinal epidural abscess associated with the use of temporary epidural catheters: report of two cases and review. Clin Infect Dis 1997;25:1155-8. PMID 9402375
96: Schwab JH, Shah AA. Spinal epidural abscess: diagnosis, management, and outcomes. J Am Acad Orthop Surg 2020;28(21):e929-38. PMID 32694325
97: Sendi P, Bregenzer T, Zimmerli W. Spinal epidural abscess in clinical practice. QJM 2008;101(1):1-12. PMID 17982180
98: Shah AA, Ogink PT, Nelson SB, Harris MB, Schwab JH. Nonoperative management of spinal epidural abscess: development of a predictive algorithm for failure. J Bone Joint Surg Am 2018;100(7):546-55. PMID 29613923
99: Shantharam G, DePasse JM, Eltorai AEM, Durand WM, Palumbo MA, Daniels AH. Physician and patients factors associated with outcome of spinal epidural abscess related malpractice litigation. Orthop Rev (Pavia) 2018;10(3):7693. PMID 30370036
100: Sheoran L, Goel N, Acharya S, Adsul N, Wattal C. A rare aetiology of spinal epidural abscess. Indian J Med Microbiol 2019;37(4):590-2. PMID 32436886
101: Shintani S, Tanaka H, Irifune A, et al. Iatrogenic acute spinal epidural abscess with septic meningitis: MR findings. Clin Neurol Neurosurg 1992;94:253-5. PMID 1382912
102: Shweikeh F, Saeed K, Bukavina L, Zyck S, Drazin D, Steinmetz MP. An institutional series and contemporary review of bacterial spinal epidural abscess: current status and future directions. Neurosurg Focus 2014;37(2):E9. PMID 25081969
103: Siddiq F, Chowfin A, Tight R, Sahmoun AE, Smego RA Jr. Medical vs surgical management of spinal epidural abscess. Arch Intern Med 2004;164:2409-12. PMID 15596629
104: Sillevis Smitt P, Tsafka A, van den Bent M, et al. Spinal epidural abscess complicating chronic epidural analgesia in 11 cancer patients: clinical findings and magnetic resonance imaging. J Neurol 1999;246:815-20. PMID 10525980
105: Smith AP, Musacchio MJ, O’Toole JE. Spinal epidural abscess associated with infliximab treatment for psoriatic arthritis. Case report. J Neurosurg Spine 2008;9(3):261-4. PMID 18928222
106: Smith RM, Schaefer MK, Kainer MA, et al. Fungal infections associated with contaminated methylprednisolone injections. N Engl J Med 2013;369(17):1598-609. PMID 23252499
107: Soehle M, Wallenfang T. Spinal epidural abscesses: clinical manifestations, prognostic factors, and outcomes. Neurosurgery 2002;51:79-85. PMID 12182438
108: Soh P, Doan N, Manning B, Doan H. Spinal cord injury from an epidural abscess as a serious complication of COVID-19 infection. Cureus 2020;12(11):e11327. PMID 33282600
109: Solera J, Lozano E, Martinez-Alfaro E, Espinosa A, Castillejos ML, Abad L. Brucellar spondylitis: review of 35 cases and literature survey. Clin Infect Dis 1999;29:1440-9. PMID 10585793
110: Spernovasilis N, Demetriou S, Bachlitzanaki M, et al. Characteristics and predictors of outcome of spontaneous spinal epidural abscesses treated conservatively: a retrospective cohort study in a referral center. Clin Neurol Neurosurg 2017;156:11-7. PMID 28284111
111: Srivastava T, Singh S, Goyal V, Shukla G, Behari M. Hypoglossal nerve paralysis caused by high cervical epidural abscess. Neurology 2006;66:522. PMID 16505305
112: Strauss I, Carmi-Oren N, Hassner A, Shapiro M, Giladi M, Lidar Z. Spinal epidural abscess: in search of reasons for an increased incidence. Isr Med Assoc J 2013;15(9):493-6. PMID 24340840
113: Suppiah S, Meng Y, Fehlings MG, Massicotte EM, Yee A, Shamji MF. How best to manage the spinal epidural abscess? A current systematic review. World Neurosurg 2016;93:20-8. PMID 27262655
114: Talamonti G, Colistra D, Crisà F, Cenzato M, Giorgi P, D'Aliberti G. Spinal epidural abscess in COVID-19 patients. J Neurol 2020;1-7. PMID 32910251
115: Tessman PA, Preston DC, Shapiro BE. Spinal epidural abscess in an afebrile patient. Arch Neurol 2004;61(4):590-1. PMID 15096411
116: Toppo AJ, Rogerson A, Oh DHW, Tybor DJ, Wurcel AG, Salzler MJ. Injection drug use in patients with spinal epidural abscess: nationwide data, 2000-2013. Spine (Phila Pa 1976) 2020;45(12):843-50. PMID 32004230
117: Tung GA, Yim JW, Mermel LA, Philip L, Rogg JM. Spinal epidural abscess: correlation between MRI findings and outcome. Neuroradiology 1999;41:904-9. PMID 10639666
118: Vakili M, Crum-Cianflone NF. Spinal epidural abscess: a series of 101 cases. Am J Med 2017;130(12):1458-63.** PMID 28797646
119: Van Bergen J, Plazier M, Baets J, Simons PJ. An extensive spinal epidural abscess successfully treated conservatively. J Neurol Neurosurg Psychiatry 2009;80(3):351-3. PMID 19228675
120: van de Warrenburg BP, Wesseling P, Leyten QH, Boerman RH. Myelopathy due to spinal epidural abscess without cord compression: a diagnostic pitfall. Clin Neuropathol 2004;23(3):102-6. PMID 15200287
121: Walkty A, Baxter M, Adam H, et al. Antimicrobial susceptibility of Pseudomonas aeruginosa isolates obtained from patients in Canadian hospitals: CANWARD 2008-2011. Diagn Microbiol Infect Dis 2012;73(4):361-4. PMID 22694789
122: Wangaryattawanich P, Condos AM, Rath TJ. Bacterial and viral infectious disease of the spine. Magn Reson Imaging Clin N Am 2024;32(2):313-33. PMID 38555143
123: Wheeler D, Keiser P, Rigamonti D, Keay S. Medical management of spinal epidural abscesses: case report and review. Clin Infect Dis 1992;15:22-7. PMID 1617070
124: Wong SS, Daka S, Pastewski A, et al. Spinal epidural abscess in hemodialysis patients: a case series and review. Clin J Am Soc Nephrol 2011;6(6):1495-500. PMID 21617087
125: Yang H, Shah AA, Nelson SB, Schwab JH. Fungal spinal epidural abscess: a case series of nine patients. Spine J 2019;19(3):516-22. PMID 30121322
126: Yazawa S, Ohi T, Sugimoto S, Satoh S, Matsukura S. Cervical spinal epidural abscess following acupuncture: successful treatment with antibiotics. Intern Med 1998;37:161-5. PMID 9550597
127: Ziu M, Dengler B, Cordell D, Bartanusz V. Diagnosis and management of primary pyogenic spinal infections in intravenous recreational drug users. Neurosurg Focus 2014;37(2):E3. PMID 25081963

Patient Profile

Age range of presentation: 1 month to 65+ years
Sex preponderance: male>female, >2:1
Heredity: none
Population groups selectively affected: none selectively affected
Occupation groups selectively affected: none selectively affected

ICD & OMIM codes

ICD-10: Intraspinal abscess and granuloma: G06.1
ICD11: Intraspinal epidural abscess: 1D03.4

Intraspinal extradural abscess: 1D03.2

This is an article preview.
Start a Free Account
to access the full version.

Nearly 3,000 illustrations, including video clips of neurologic disorders.
Every article is reviewed by our esteemed Editorial Board for accuracy and currency.
Full spectrum of neurology in 1,200 comprehensive articles.
Listen to MedLink on the go with Audio versions of each article.

Questions or Comment?

MedLink®, LLC

3525 Del Mar Heights Rd, Ste 304
San Diego, CA 92130-2122

Toll Free (U.S. + Canada): 800-452-2400

US Number: +1-619-640-4660

Support: service@medlink.com

Editor: editor@medlink.com

ISSN: 2831-9125

Spinal epidural abscess

Associated Disorders

Bacterial endocarditis
Diabetes mellitus
Intravenous drug abuse
Paraplegia
Spinal cord infarction
- Spinal discitis
- Spinal osteomyelitis
- Spine trauma
- Tetraplegia

Differential Diagnosis

acute abdomen
spinal osteomyelitis
spinal subdural empyema
spinal epidural hemorrhage
spinal epidural tumor

Also Relevant

Intracranial epidural abscess
Spinal subdural empyema

Clinical Categories

Infectious Disorders

Patient Handouts

Nerve disease and bladder control

Spinal epidural abscess …

Spinal epidural abscess

Introduction

Overview

Key points

Historical note and terminology

Clinical manifestations

Presentation and course

Prognosis and complications

Clinical vignette

Biological basis

Etiology and pathogenesis

Epidemiology

Prevention

Differential diagnosis

Diagnostic workup

Management

Special considerations

Pregnancy

Anesthesia

Media

References

Contributors

Author

Patient Profile

ICD & OMIM codes

This is an article preview.
Start a Free Account
to access the full version.

Questions or Comment?

Also in This Category

Neuropathies associated with cytomegalovirus infection

Genital herpes: neurologic complications

Neurocysticercosis

Zika virus: neurologic complications

Gram-negative bacillary meningitis

Pneumococcal meningitis

HTLV-1 associated myelopathy

Infective endocarditis

Spinal epidural abscess

Introduction

Overview

Key points

Historical note and terminology

Clinical manifestations

Presentation and course

Prognosis and complications

Clinical vignette

Biological basis

Etiology and pathogenesis

Epidemiology

Prevention

Differential diagnosis

Diagnostic workup

Management

Special considerations

Pregnancy

Anesthesia

Media

References

Contributors

Author

Patient Profile

ICD & OMIM codes

This is an article preview. Start a Free Account to access the full version.

Questions or Comment?

Also in This Category

Neuropathies associated with cytomegalovirus infection

Genital herpes: neurologic complications

Neurocysticercosis

Zika virus: neurologic complications

Gram-negative bacillary meningitis

Pneumococcal meningitis

HTLV-1 associated myelopathy

Infective endocarditis

This is an article preview.
Start a Free Account
to access the full version.