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超越风险因素:一名年轻健康患者的脊柱硬膜外脓肿

Beyond Risk Factors: Spinal Epidural Abscess in a Young, Healthy Patient.

作者信息

Guimarães Diana, Silva Mariana, Morgado Sílvia, Reis Lígia, Fernandes Paula

机构信息

Anesthesiology, Unidade Local de Saúde do Alentejo Central, Évora, PRT.

出版信息

Cureus. 2024 Nov 25;16(11):e74397. doi: 10.7759/cureus.74397. eCollection 2024 Nov.

Abstract

Epidural abscess is a rare complication of neuraxial techniques, which, when left unnoticed, can lead to significant neurological deficits and poor outcomes. Identification of patients at high risk and the conduct of a strict aseptic technique are some of the measures that play an important role in epidural abscess prevention. Prompt recognition and treatment of epidural abscesses are essential. Close monitoring in the perioperative period for new-onset clinical signs and symptoms is of major importance. When an epidural abscess is suspected, early laboratory assessment and magnetic resonance imaging (MRI) are indicated. Treatment options include early empiric and posteriorly antibiogram-guided antibiotic therapy and surgical decompression of the epidural abscess. This case presents a young male patient with no significant medical history or predisposing risk factors who developed an epidural abscess following epidural catheter placement for osteosynthesis of a left tibial plateau fracture. The patient's absence of additional predisposing conditions, besides two attempts at epidural catheter placement, underscores the complexity and unpredictability of such infections.

摘要

硬膜外脓肿是神经轴技术的一种罕见并发症,若未被察觉,可导致严重的神经功能缺损和不良预后。识别高危患者并实施严格的无菌技术是预防硬膜外脓肿的重要措施。及时识别和治疗硬膜外脓肿至关重要。围手术期密切监测新发临床体征和症状至关重要。怀疑有硬膜外脓肿时,应进行早期实验室评估和磁共振成像(MRI)检查。治疗选择包括早期经验性及根据药敏结果指导的抗生素治疗以及硬膜外脓肿的手术减压。该病例为一名无重大病史或易感危险因素的年轻男性患者,在为左胫骨平台骨折进行骨合成而放置硬膜外导管后发生了硬膜外脓肿。除了两次硬膜外导管置入尝试外,患者无其他易感情况,这凸显了此类感染的复杂性和不可预测性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/17bd/11669180/9e7749de5f2e/cureus-0016-00000074397-i01.jpg

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