TITLE:
Isolated Spinal Subdural Empyema: A Case Report & Review of the Literature
AUTHORS:
Rudy D. Marciano, Ward Buster, Chris Karas, Kailash Narayan
KEYWORDS:
Subdural Empyema, Subdural Abscess, Spinal Subdural Empyema, Epidural Abscess, Infection, Spinal Infection
JOURNAL NAME:
Open Journal of Modern Neurosurgery,
Vol.7 No.3,
July
26,
2017
ABSTRACT: Background: Spinal subdural empyema (SSE) is rare, with less than 70 case reports in
adults. The pathomechanism of infection and vulnerable patient populations have
yet to be delineated. Reported outcomes are varied. Case Description: Case report of an isolated spinal subdural empyema with no obvious source in a
65-year-old female presenting with an acute neurologic deficit requiring
emergent surgical intervention. A Pub Med search of keywords “Spinal Subdural
Empyema” and/or “Spinal Subdural Abscess” with review of all associated English
language literature was conducted. Pertinent data were compiled, analyzed, and
placed into chart and graph format. Conclusions: SSE is rare and often
progresses in 3 separate chronologic stages; pain/fever, neurologic deficit,
and paralysis. Tenderness to palpation is often absent. 3 methods of spread
have been postulated: hematogenous, contiguous, and iatrogenic. Staphylococcus aureus is the most common
infecting organism. The lumbar spine, followed closely by the thoracic spine,
is most commonly affected. Contrasted MRI is the preferred diagnostic modality.
Emergent surgical SSE evacuation followed by parenteral antibiotics is recommended,
as surgical outcomes are far superior to non-surgical management. The patient
featured in this case made a full neurologic recovery by 6-month follow-up.