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CC BY 4.0 · Arq Neuropsiquiatr 2024; 82(S 02): S53-S176
DOI: 10.1055/s-0045-1807131
ID: 755
Area: Neuroinfections
Presentation method: Eletronic Poster

Acute spinal cord syndrome secondary to medullary epidural empyema: case report

Maria Beatriz Bravin
1   Universidade do Estado de São Paulo, Botucatu SP, Brazil.
,
Gabriela de Castro Fim
1   Universidade do Estado de São Paulo, Botucatu SP, Brazil.
,
Lucas Barbosa Napolitano de Moraes
1   Universidade do Estado de São Paulo, Botucatu SP, Brazil.
,
Lara Cristina Antunes dos Santos
1   Universidade do Estado de São Paulo, Botucatu SP, Brazil.
,
Augusto Ventura Ceranto
1   Universidade do Estado de São Paulo, Botucatu SP, Brazil.
,
Bruna Eugenia Gomes Felipe
1   Universidade do Estado de São Paulo, Botucatu SP, Brazil.
,
Lethícia Nogueira Santos Barreto
1   Universidade do Estado de São Paulo, Botucatu SP, Brazil.
,
Heloisa Carolina Massucato Bravin
1   Universidade do Estado de São Paulo, Botucatu SP, Brazil.
,
Mirelle Tristao De Souza
1   Universidade do Estado de São Paulo, Botucatu SP, Brazil.
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    *Correspondence: beatriz_pva@hotmail.com.

    Abstract

    Epidural empyema has a prevalence of 1 in 20,000 hospital admissions, being an uncommon infectious entity. The reported case addresses the clinical evolution of an adolescent with acute medullary signs secondary to medullary epidural empyema compression as a complication of acute meningitis.

    Case Presentation: JGR, 13 years old, previously healthy, was admitted to the emergency service complaining of changes in lower limb movements, urinary retention and headache that started 5 days ago, hyaline coryza, hyperthermia (not measured) for 7 days and no history of previous trauma. On physical examination, he presented flaccid and symmetrical paresis and absence of osteotendinous reflexes in the lower limbs, and presence of kerning and brudzinski meningeal signs. Contrast-enhanced cranial tomography showed no signs of intracranial hypertension and liqueur puncture showed infectious signs and isolation of Streptococcus pneumoniae in culture. However, in the MRI findings of the spinal cord, epidural empyema with compression at the lumbosacral level and cauda equina was identified. Treatment was initiated according to an antibiogram with progressive remission of signs and symptoms in 15 days. The unusual aspect in this case is related to the rapid evolution to epidural empyema in a young and previously healthy patient.

    Discussion: Medullary epidural empyemas are usually related to bacteremia or direct extension of a nearby infectious focus, but rarely result from complications of acute meningitis or lumbar puncture, as they are manifested by a painful and febrile medullary syndrome, usually subacute. The diagnosis is made through imaging and the gold standard treatment is based on prolonged antibiotic therapy and surgical drainage in the indicated cases.

    Final Comments: Therefore, it is concluded that epidural empyema should be considered in cases of bacterial meningitis, since it proves to be a diagnostic and therapeutic challenge, given its nonspecific clinical and laboratory signs and, even though it is a rare complication, it should be investigated in patients with acute spinal cord syndrome and infectious signs


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    Publication History

    Article published online:
    12 May 2025

    © 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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