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[Spinal epidural abscess with persistent increase in cerebrospinal fluid protein: a case study]
Kenjiro Mitsuhashi1, Tomomi Nakamura, Shiori Hashimoto
1Department of Neurology, Neurological Institute, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
No to Shinkei = Brain and Nerve
|November 24, 2004
Summary
A 67-year-old hemodialysis patient developed bacterial meningoencephalitis due to Methicillin-resistant Staphylococcus aureus (MRSA) sepsis. Spinal epidural abscess was diagnosed and successfully treated with targeted antibiotics, though high cerebrospinal fluid protein persisted.
Area of Science:
- Infectious Diseases
- Neurology
- Neurosurgery
Background:
- A 67-year-old male undergoing hemodialysis presented with symptoms suggestive of central nervous system infection.
- The patient had a known Methicillin-resistant Staphylococcus aureus (MRSA) sepsis originating from a dialysis shunt infection.
Observation:
- Initial diagnosis included bacterial meningoencephalitis, treated with antibiotics.
- Cerebrospinal fluid analysis revealed persistent high protein levels (898 mg/dl) despite normalized cell counts.
- Cervical MRI identified deep neck and cervical spinal epidural abscesses from C2 to C5.
Findings:
- Spinal epidural abscess (SEA) was confirmed as the underlying pathology.
- Intensive, MRSA-targeted antibiotic chemotherapy led to abscess eradication and clinical improvement.
- Persistent elevation of cerebrospinal fluid protein levels may indicate residual or resolving SEA.
Implications:
- Early and accurate diagnosis of SEA in immunocompromised patients is crucial.
- MRSA-specific antibiotic regimens are effective in treating spinal epidural abscesses.
- Monitoring cerebrospinal fluid protein levels can aid in assessing treatment response and disease activity in SEA.