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Spinal subdural empyema in an immunocompetent patient: illustrative case
Shreyas Thiruvengadam1, Boyuan Khoo1, Snigdha Saha1
1Department of Neurosurgery, Sir Charles Gairdner Hospital, Perth, Western Australia.
Background:
Spinal subdural empyemas are a rare presentation of rapid neurological decline, progressing from radiculopathy to complete paralysis and sensory loss. Although pathogenic mechanisms have been hypothesized, their occurrence in this population of patients remains unclear.
Observations:
The authors present the third documented case of an isolated spinal subdural empyema of unclear etiology in an immunocompetent patient with no established risk factors.
Lessons:
Successful treatment requires prompt clinical suspicion, radiological diagnosis, and surgical evacuation along with empirical antibiotic treatment. Radiological clarification of the subdural versus the epidural location of the empyema is difficult, while intraoperative durotomy for exploration risks subdural dissemination. In these cases, intraoperative ultrasonography would be a useful adjunct and decision aid. https://thejns.org/doi/10.3171/CASE24464.
Insights
Spinal subdural empyemas can cause rapid paralysis. Prompt diagnosis and surgical evacuation are crucial for successful treatment, especially in immunocompetent patients with unknown causes.
Area of Science:
- Neurology
- Neurosurgery
- Infectious Disease
Background:
- Spinal subdural empyema is a rare condition causing rapid neurological decline.
- Pathogenic mechanisms are not fully understood, particularly in immunocompetent individuals.
- This case highlights an isolated empyema of unclear etiology in an immunocompetent patient.
Purpose of the Study:
- To present the third documented case of an isolated spinal subdural empyema of unclear etiology.
- To discuss diagnostic and therapeutic challenges associated with spinal subdural empyema.
- To emphasize the importance of prompt intervention and potential adjuncts in management.
Main Methods:
- Case report presentation.
- Review of clinical presentation, diagnostic imaging, and treatment.
- Discussion of diagnostic difficulties and surgical considerations.
Main Results:
- The patient presented with rapid neurological decline.
- Diagnosis and differentiation from epidural empyema were challenging.
- Successful treatment involved surgical evacuation and antibiotics.
Conclusions:
- Prompt clinical suspicion, radiological diagnosis, and surgical evacuation are essential for successful treatment.
- Distinguishing subdural from epidural empyema radiologically can be difficult.
- Intraoperative ultrasonography may aid in decision-making during surgery to prevent subdural dissemination.
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