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Old 05-20-2012
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Neuro Epidural abscess Rx

MTB2 say epidural abscess presenting with compression sx --> first step is to give steroid --> then give Abx (vanco ...). surgery if large (did define how large)

UW say epidural abscess suspected with compression sx --> emergent MRI --> immediate surgical debridement to avoid long term neurological sequelae

how should we proceed ?/
i'll go with Steroid with if sx of compression then give Abx then MRI then Surgery
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Old 05-20-2012
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epidural abscess ->cord compression
so mx is same as that of patient presenting with cord compression. that means acutely, patient should get steroid and then MRI and then decompression. this what i think. not sure...comments?
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Old 05-21-2012
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Quote:
Originally Posted by tyagee View Post
epidural abscess ->cord compression
so mx is same as that of patient presenting with cord compression. that means acutely, patient should get steroid and then MRI and then decompression. this what i think. not sure...comments?
so Steroid with if sx of compression then draw blood 4 culture & give Abx then MRI then Surgery, reasonable haa
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Old 05-21-2012
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Quote:
Originally Posted by bisho View Post
so Steroid with if sx of compression then draw blood 4 culture & give Abx then MRI then Surgery, reasonable haa
-from medscape:
If medical therapy is to be used as initial therapy for spinal epidural abscess and surgery held in reserve, a number of caveats apply, as follows:
  • The patient should have no neurological deficits.
  • A culture-proven microbiological diagnosis should be available (from blood culture or aspiration).
  • Stringent follow-up by both the primary team and neurosurgeons must be available and emergent surgery available, if needed.
  • The physicians caring for the patient must be aware that rapid deterioration may occur at any time (the first 72 hours being most risky) and that even prompt rescue surgery may leave the patient with a neurological deficit that might have been avoided with surgery at first diagnosis.
  • A follow-up MRI is necessary within 2-4 weeks to evaluate for improvement with medical therapy.
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bisho (05-21-2012)
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Old 05-21-2012
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Quote:
Originally Posted by tyagee View Post
epidural abscess ->cord compression
so mx is same as that of patient presenting with cord compression. that means acutely, patient should get steroid and then MRI and then decompression. this what i think. not sure...comments?
You forgot Antibiotics---which are the mainstay of treatment (MTB--treated similar to IE). Steroids only buys you time but you have to treat the cause.
MRI if neurological s/s and/or no/minimal improvement with above>>>>>>followed by surgical decompression.
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