CNS Abscesses

Question 1

Clinical presentation of spinal epidural abscess:

Answer 1

STAGE 1
- Back pain
STAGE 2
- Nerve root pain
STAGE 3
- Weakness, sensory, bowel/bladder
STAGE 4
- Paralysis

Tenderness in non-contiguous vertebrae- ‘skip lesions’

Often missed!!!!
HAVE HIGH INDEX SUSPICION

Question 2

Antibiotics in epidural abscess:

Answer 2

Typically skin organisms: MSSA, MRSA, S. epidermidis.
Gram negs (pseudomonas, E.Coli, acetino, klebsiella).

Ceftriaxone 2g twice daily
PLUS
Vancomycin 30-60mg/kg (MRSA) twice daily
–> 6 weeks min.

Question 3

Risk factors for epidural abscess:

Answer 3

Immunosuppressed
IVDU
Alcohol
Spinal surgery/instrumentation
Indwelling lines
Concurrent infection:
–> Contiguous
–> Haematogenous
Elderly

NO source found is common.

Question 4

Common sources of brain abscess:

Answer 4

Direct spread, haematogenous

Cardioembolic (endocarditis)

ENT
–> Otitis media/ mastoiditis
–> Sinuses
–> Throat
–> Dental