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Abdominal pain from a thoracic epidural abscess.
Erle Chuen-Hian Lim1, Raymond C S Seet
1Division of Neurology, National University Hospital, Singapore, Singapore. mdcelch@nus.edu.sg
Journal of General Internal Medicine
|April 12, 2006
Summary
Spinal epidural abscesses can cause severe neurological deficits. Prompt diagnosis and surgical drainage are crucial for recovery, as demonstrated by this case of a woman with thoracic myelopathy.
Area of Science:
- Neurology
- Neurosurgery
- Infectious Disease
Background:
- Spinal epidural abscesses (SEA) present diagnostic challenges and carry significant risks of morbidity and mortality.
- Early symptoms can be nonspecific, potentially delaying diagnosis and treatment.
Observation:
- A 61-year-old woman presented with epigastric pain and constipation after a fall, initially with normal examination.
- She later developed urinary retention and progressive paraplegia, indicative of thoracic myelopathy.
- Neuroimaging revealed a thoracic spinal epidural collection compressing the spinal cord at T8.
Findings:
- Emergent neurosurgical intervention successfully drained the epidural abscess.
- The patient received a 9-week course of antibiotics.
- Full neurological recovery was achieved following treatment.
Implications:
- Thoracic spinal pathology, including epidural abscesses, can manifest with symptoms mimicking intra-abdominal conditions.
- A high index of suspicion is vital for early diagnosis of SEA.
- Prompt neurosurgical intervention and appropriate antibiotic therapy are essential to prevent devastating neurological outcomes.