Spinal subdural or epidural abscess

Question 1

Usually due to

Answer 1

Staph. aureus

difficult to diagnose

Question 2

Clinical features

Answer 2

Back pain (increasing) ± radiculopathy

Percussion tenderness over spine

Evolving neurological deficit, e.g.

gradual leg weakness + sensory loss ± fever (may be absent)

Question 3

Investigations

Answer 3

difficult to diagnose

Blood culture

MRI scan to localise abscess

Question 4

Management is

Answer 4

urgent neurosurgical referral.

Consider IV empirical therapy, e.g.

• di/flucloxacillin
• gentamicin while awaiting culture