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[Subdural empyema due to Mycoplasma hominis following epidural anesthesia]
F Escamilla1, M D Fernández, A Espigares
1Servicio de Neurología, Hospital Universitario Virgen de las Nieves, Granada, España. neuro2000@hvn.sas.cica.es
Introduction:
In the literature there are sporadic reports of spinal epidural abscesses after epidural anaesthesia (Staphylococcus aureus in 82%), whilst subdural empyemas are more often related to ear and sinus conditions.
Clinical Case:
A 32 year old woman with a clinical history of migraine and symmetrical frontal atrophy on a previous cerebral CT scan, after Caesarean section under epidural anaesthesia, presented with orthostatic headache two days later. On the fourth day it had become constant and she had a high temperature which was considered to be caused by infection of the surgical wound. Neurological examination was found to be normal, the CT scan was inconclusive and the CSF showed a lymphocytic pleocytosis without consumption of glucose. In view of her worsening clinical condition on the ninth day, in the absence of a cutaneous focus and on suspicion of a para-meningeal infective focus, lumbar MR was done and found to be normal, and cerebral MR which showed images compatible with a right fronto-parietal subdural empyema. After a parietal craniotomy and culture of the surgical specimen, colonies of Mycoplasma hominis were grown, similar to those grown from the exudates of the abdomical surgical wound. Treatment was started with ciprofloxacine.
Conclusion:
We consider that following epidural anaesthesia the patient developed hypotension of the CSF with a secondary subdural hematoma or hygroma and this became infected by hematogenous spread of Mycoplasma hominis.
Insights
A rare case of subdural empyema following epidural anesthesia is presented. Mycoplasma hominis infection of a cerebrospinal fluid (CSF) collection, likely secondary to hypotension, was identified.
Area of Science:
- Neurology
- Infectious Diseases
- Anesthesiology
Background:
- Spinal epidural abscesses are sporadically reported after epidural anesthesia.
- Subdural empyemas are typically associated with ear and sinus infections.
Observation:
- A 32-year-old woman developed a subdural empyema after Cesarean section under epidural anesthesia.
- Initial symptoms included orthostatic headache, fever, and lymphocytic pleocytosis in CSF.
- Cerebral MRI revealed a right fronto-parietal subdural empyema.
Findings:
- Cultures identified Mycoplasma hominis in both the subdural empyema and the abdominal surgical wound.
- The subdural empyema is hypothesized to have arisen from a CSF collection secondary to epidural-induced hypotension, with subsequent hematogenous spread of infection.
Implications:
- This case highlights a rare complication of epidural anesthesia.
- Mycoplasma hominis should be considered in the differential diagnosis of subdural empyemas, particularly in postpartum patients.
- Prompt diagnosis and appropriate antibiotic treatment are crucial for favorable outcomes.