%0 Journal Article
%T Absceso epidural espinal: presentaci車n at赤pica
%A Guillermo Castillo
%J Revista Argentina de Neurocirug赤a
%D 2006
%I 
%X Objetivo. Describir un nuevo caso de absceso epidural espina (AES) con presentaci車n at赤pica. Descripci車n. Se describe una paciente sin antecedentes patol車gicos, afebril, laboratorio normal, con lumboci芍tica de 4 meses de evoluci車n. Al examen mostr車 lumbalgia y ci芍tica S1 irritativa, Lasegue + 40∼, e IRM que inform車 extrusi車n discal masiva subligamentosa. Se intervino con diagn車stico de hernia de disco. Intervenci車n. Se abord車 mediante abordaje posterior y hemilaminotom赤a L5 S1 izq. Al repliegue del saco man車 pus, lo que modific車 el planteo, ampliando laminectom赤a L5 con extensi車n hasta extremos sanos. Cuidadosa toilette y drenaje. La paciente evolucion車 satisfactoriamente, pero el seguimiento por IRM mostr車 compromiso osteomiel赤tico secundario lo que oblig車 a tratamiento antibi車tico durante 6 meses, con curaci車n cl赤nica y por im芍genes. Conclusi車n. Si bien el caso se present車 como de diagn車stico y resoluci車n sencilla, durante el acto quir迆rgico se modifica el planteo. Siempre se deben tener presentes las patolog赤as menos frecuentes para poder resolverlas adecuadamente. El AES debe considerarse una emergencia m谷dico quir迆rgica. Objective: to describe a new case of spinal epidural abscess with an atypical presentation. Description: a female patient with 41 years-old, with a normal previous history and laboratory tests, presented with a 4 months history of bilateral ciatic and back pain. Clinical examination showed a left Lasegue sign. Magnetic resonance showed an image of massive lumbar herniated disc. Intervention: she was taken to surgery and an hemilaminectomy was performed. Only pus was obtained that was positive for stafilococus aureus. Ciatic pain dissapeared but in spite of the antibiotic treatmen back pain persisted. A new magnetic resonance performed 4 weeks later showed signs of spondylodiscitis in L4-L5 and L5-S1. With the antibiotic treatment the images normalized after 6 months. Conclusion. The case seemed to be simple but during surgery the diagnosis was modified. Less frequent pathologies should always be considered. The epidural spinal abscess should be treated as a surgical emergency.
%K Absceso peridural
%K Espondilodiscitis
%K Hernia de disco
%K IRM
%K Discal hernia
%K Epidural abscess
%K Magnetic resonance imaging
%K Spondylodiscitis
%U http://www.scielo.org.ar/scielo.php?script=sci_arttext&pid=S1850-15322006000100008