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Article Review/Hyperlink |
Obrador GT, Levenson DJ
Spinal epidural abscess in hemodialysis patients: report of three cases and review of the literature
Am J Kidney Dis (Jan) 27:75-83 1996
Spinal epidural abscess is a rare but serious neurological complication in hemodialysis patients. Obrador and Levenson describe 3 patients and review 9 additional cases in detail from other series. Most such cases are related to S. aureus infection from either the graft or an infected skin ulcer. Presenting complaints are fever, backache, local spinal tenderness, leg pain and weakness, sphincter dysfunction, paresis and/or paralysis. MRI appears to be less sensitive (80%) than computed tomography-myelography. Plain CT scanning without myelography has low sensitivity and can give misleading results (e.g., disc protrusion).
Of the 12 patients reviewed, one died and eight had severe neurologic deficits, including two with paralysis. Early (immediate) decompressive surgery usually is advised, although rare patients can be treated with antibiotics only. (John T. Daugirdas, M.D., Univ. of IL at Chicago)
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