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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
PubMed

Insights

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.

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