Empiema espinhal subdural relato de um caso: case report

Magalhães, Gerson Canedo de; Rocha, José Roberto Coelho da; Souza, Luís Alberto M.; Salomão, José Francisco; Jevoux, Carla; Carneiro, Welmer

doi:10.1590/S0004-282X1995000100020

Resumos

A raridade do empiema subdural pode ser verflcada pela escassez de casos descritos na literatura. Os autores apresentam mais um caso, mostrando as dificuldades diagnosticas principalmente quando não há aparente porta de entrada. Enfatizam, nestas circunstâncias, a importância de certos sinais clínicos, o valor da punção lombar e da imagem por ressonância nuclear magnética na elucidação diagnóstica. Este último exame não foi mencionado anteriormente na literatura consultada sobre o assunto. O tratamento cirúrgico, associado à antibioticoterapia, mostrou- se bastante eficaz, principalmente se realizado precocemente.

empiema espinhal subdural; empiema subdural; empiema intratecal; abscesso espinhal; paquimeningite tóraco-lombar

Spinal subdural empyema is a very unusual condition. About 40 cases have been previously reported. The authors describe another case, mentioning the difficulties in diagnosis particularlry when no primary infection is known. In these circumstances, the neurological signs and MRI are important; MRI demonstrates the level of the lesion and its subdural localization. Surgical treatment and antibiotics are clearly indicated and the earliest it is done, the better the results.

spinal subdural empyema; subdural empyema; intrathecal empyema; spinal abscess; pachymeningitiis

Empiema espinhal subdural relato de um caso

Spinal subdural empyema: case report

Gerson Canedo de Magalhães^I; José Roberto Coelho da Rocha^II; Luís Alberto M. Souza^III; José Francisco Salomão^IV; Carla Jevoux^V; Welmer Carneiro^VI

^IProfessor Titular de Neurologia da Universidade do Estado do Rio de Janeiro (UERJ), e do Instituto de Pós-Graduação Carlos Chagas (IPGCC), Chefe do Serviço de Neurologia do HBPRJ

^IIProfessor Titular de Nefrologia da Faculdade de Medicina Souza Marques e do IPGCC, Chefe do Serviço de Nefrologia do HBPRJ

^IIIChefe do Serviço de Ressonância Magnética do HBPRJ

^IVChefe do Serviço de Neurocirurgia do Instituto Fernandes Figueira

^VMédica Pós-Graduanda do Serviço de Neurologia do HBPRJ

^VIMédico Pós-Graduando do Serviço de Nefrologia do HBPRJ

RESUMO

A raridade do empiema subdural pode ser verflcada pela escassez de casos descritos na literatura. Os autores apresentam mais um caso, mostrando as dificuldades diagnosticas principalmente quando não há aparente porta de entrada. Enfatizam, nestas circunstâncias, a importância de certos sinais clínicos, o valor da punção lombar e da imagem por ressonância nuclear magnética na elucidação diagnóstica. Este último exame não foi mencionado anteriormente na literatura consultada sobre o assunto. O tratamento cirúrgico, associado à antibioticoterapia, mostrou- se bastante eficaz, principalmente se realizado precocemente.

Palavras chave: empiema espinhal subdural, empiema subdural, empiema intratecal, abscesso espinhal, paquimeningite tóraco-lombar.

SUMMARY

Spinal subdural empyema is a very unusual condition. About 40 cases have been previously reported. The authors describe another case, mentioning the difficulties in diagnosis particularlry when no primary infection is known. In these circumstances, the neurological signs and MRI are important; MRI demonstrates the level of the lesion and its subdural localization. Surgical treatment and antibiotics are clearly indicated and the earliest it is done, the better the results.

Key-words: spinal subdural empyema, subdural empyema, intrathecal empyema, spinal abscess, pachymeningitiis.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 23-agosto-1994.

Dr. Gerson Canedo de Magalhães - Rua Almirante Pereira Guimarães 37 apto 401 - 22440-000 Rio de Janeiro RJ - Brasil.

Serviços de Neurologia, Nefrologia e Neuroimagem do Hospital da Beneficência Portuguesa do Rio de Janeiro (HBPRJ)

1. Altrocchi PH. Acute spinal epidural abcess vs. acute transverse myelopathy: a plea for neurosurgical caution. Arch Neurol 1963, 9:17-25.
2. Case Records of the Massachusetts General Hospital (Case 10). N Engl J Med 1977, 296.
3. Case Records of the Massachetts General Hospital (Case 47). N Engl J Med 1984, 1365-1370.
4. Dus V. Spinal peripachymeningitis (epidural abscess): report of eight cases. J Neurosurg 1960, 17: 972-983.
5. Fraser RAR, Ratzan K, Wolpert SM et al. Spinal subdural empyema. Arch Neurol 1973, 28:235-238.
6. Griffiths HE, Jones DM. Pyogenic infection of the spine: a review of twenty-eight cases. J Bone Joint Surg 1971, 53 B: 383-391.
7. Harris LF, Haws FP, Triplett JN Jr, MacCubbin DA. Subdural empyema and epidural abscess: recent experience in a community hospital. Southn Med J 1987, 80: 1254-1258.
8. Messer HD, Lenchner GS, Brust JCM, Resor S. Lumbar spinal abcess managed conservatively: case report. J Neurosurg 1977, 46: 825-829.
9. Negrin J Jr, Clark RA Jr. Pyogenic subdural abscess of the spinal meninges :report of two cases. J Neurosurg 1952, 9:95-100.
10. Patronas NJ, Marx WJ. Radiographic presentation of spinal abscess in the subdural space. AJR 1979, 9:132-138.
11. Pritchard AE, Robinson MP. Staphylococcal infection of the spine. Lancet 1961, 2:1165.
12. Probst CH, Wicki G. Spinale subdurale Empyeme und Abszesse. Schw Arch Neurol Psych 1984, 134:53-70.
13. Schiller F, Shade OW. Extratecal and intratecal suppuration :report of two cases and discussion of the spinal subdural space. Arch Neurol 1962, 7:33-36.
14. Stone DB, Bonfiglio M. Pyogenic verebral osteomyelites: a diagnostic pitfall for internist. Arch Intern Med 1963,112:491-500.
15. Taper JB, Giesecke AH. Spinal anaesthesia in a child with job's syndrome, pneumatoceles and empyema. Anaesthesia 1990, 45:378-380.
16. Wright RL. Intramedullary spinal cord abscess: report of a case secondary to stab wound with good recovery following operation. J Neurosurg 1965, 23:208-210.
17. Wright RL. Infecctions of the spine and spinal cord. In Youmans JR (ed). Neurological surgery. Philadelphia. Saunders, 1973, p 1574-1583.
18. Zilkha A, Nicoletti JM. Acute spinal subdural hematoma: case report. J Neurosurg 1974, 41:627-630.

Datas de Publicação

Publicação nesta coleção
19 Jan 2011
Data do Fascículo
Mar 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Altrocchi PH. Acute spinal epidural abcess vs. acute transverse myelopathy: a plea for neurosurgical caution. Arch Neurol 1963, 9:17-25.

[2] 2. Case Records of the Massachusetts General Hospital (Case 10). N Engl J Med 1977, 296.

[3] 3. Case Records of the Massachetts General Hospital (Case 47). N Engl J Med 1984, 1365-1370.

[4] 4. Dus V. Spinal peripachymeningitis (epidural abscess): report of eight cases. J Neurosurg 1960, 17: 972-983.

[5] 5. Fraser RAR, Ratzan K, Wolpert SM et al. Spinal subdural empyema. Arch Neurol 1973, 28:235-238.

[6] 6. Griffiths HE, Jones DM. Pyogenic infection of the spine: a review of twenty-eight cases. J Bone Joint Surg 1971, 53 B: 383-391.

[7] 7. Harris LF, Haws FP, Triplett JN Jr, MacCubbin DA. Subdural empyema and epidural abscess: recent experience in a community hospital. Southn Med J 1987, 80: 1254-1258.

[8] 8. Messer HD, Lenchner GS, Brust JCM, Resor S. Lumbar spinal abcess managed conservatively: case report. J Neurosurg 1977, 46: 825-829.

[9] 9. Negrin J Jr, Clark RA Jr. Pyogenic subdural abscess of the spinal meninges :report of two cases. J Neurosurg 1952, 9:95-100.

[10] 10. Patronas NJ, Marx WJ. Radiographic presentation of spinal abscess in the subdural space. AJR 1979, 9:132-138.

[11] 11. Pritchard AE, Robinson MP. Staphylococcal infection of the spine. Lancet 1961, 2:1165.

[12] 12. Probst CH, Wicki G. Spinale subdurale Empyeme und Abszesse. Schw Arch Neurol Psych 1984, 134:53-70.

[13] 13. Schiller F, Shade OW. Extratecal and intratecal suppuration :report of two cases and discussion of the spinal subdural space. Arch Neurol 1962, 7:33-36.

[14] 14. Stone DB, Bonfiglio M. Pyogenic verebral osteomyelites: a diagnostic pitfall for internist. Arch Intern Med 1963,112:491-500.

[15] 15. Taper JB, Giesecke AH. Spinal anaesthesia in a child with job's syndrome, pneumatoceles and empyema. Anaesthesia 1990, 45:378-380.

[16] 16. Wright RL. Intramedullary spinal cord abscess: report of a case secondary to stab wound with good recovery following operation. J Neurosurg 1965, 23:208-210.

[17] 17. Wright RL. Infecctions of the spine and spinal cord. In Youmans JR (ed). Neurological surgery. Philadelphia. Saunders, 1973, p 1574-1583.

[18] 18. Zilkha A, Nicoletti JM. Acute spinal subdural hematoma: case report. J Neurosurg 1974, 41:627-630.