Case challenge · Neurosurgery / Infectious disease / Emergency · teaching

Spinal Epidural Abscess — Management Pathway · case challenge

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Case #1Neurosurgery / Infectious disease / Emergency

📋 Case data

Neurological deficit?Neurological deficit / progressing

Data is taken from this pathway's reviewed node text. Work through the pathway step by step.

Step 1 / 1 · Neurological deficit?

Back pain + fever ± neuro deficit — is there a neurological deficit?

💡 Pyogenic infection of the epidural space → cord injury from compression/ischemia (Staph aureus most common including MRSA, lumbar predominant). Risk factors: diabetes (most common), IV drug use, immunosuppression, alcohol misuse, spinal surgery/puncture, indwelling catheter, distant infection. The classic triad (back pain + fever + neuro deficit) is complete in only ~10–15%; back pain is most common and neuro deficit is a late sign (pain → radicular pain → motor-sensory/sphincter dysfunction → paralysis); about half are initially misdiagnosed. CRP >10 is highly sensitive (a normal value makes SEA unlikely). Diagnosis: whole-spine contrast MRI (gold standard, to find skip lesions) — non-contrast can miss it, contrast is needed.

For teaching. Decisions and their basis are taken from this site's reviewed care pathways; for licensed clinicians/trainees, this does not replace clinical judgment or local protocols.