Examkin

Soru

Zorluk: OrtaNeurosurgery

A ward nurse urgently pages the on-call surgical team regarding a hospitalized 51-year-old man. The patient was admitted three days ago for bacteremia secondary to a skin infection and has been receiving targeted intravenous therapy. Over the last eight hours, he developed severe, progressive mid-back pain and new-onset difficulty moving his legs. His temperature is 39.2∘C39.2^\circ\text{C} (102.6∘F102.6^\circ\text{F}). Neurologic examination reveals 2/52/5 motor strength in bilateral lower extremities, loss of pain and temperature sensation below the umbilicus, and a distended, palpable bladder. Immediate magnetic resonance imaging of the spine demonstrates a large, peripherally enhancing epidural fluid collection at the T9-T10 level compressing the spinal cord. Which of the following is the most appropriate next step in the management of this patient?

  1. Emergent surgical decompressionCevap
  2. B
    Initiation of high-dose intravenous dexamethasone
  3. C
    Addition of broad-spectrum empirical antibiotics and clinical observation
  4. D
    Computed tomography-guided percutaneous drainage
  5. E
    Lumbar puncture for cerebrospinal fluid analysis

Cevap

Emergent surgical decompression
The correct answer is emergent surgical decompression. This patient presents with a spinal epidural abscess complicated by rapid-onset lower extremity weakness and bladder dysfunction, indicating acute spinal cord compression. In the presence of new or worsening neurologic deficits, immediate surgical decompression (typically via laminectomy) and debridement are required to relieve pressure on the spinal cord. Early surgical intervention is critical to prevent irreversible ischemic injury and permanent paralysis. Medical management alone is insufficient once mechanical neurologic compromise begins.

Adım Adım Çözüm

1
Analyze the clinical presentation.
The patient exhibits the classic triad of a spinal epidural abscess (fever, back pain, and neurologic deficits), with new-onset paraparesis and autonomic dysfunction.
Identifying the rapid progression of neurologic compromise establishes this as a surgical emergency.
2
Correlate with imaging findings.
Spinal MRI confirms a peripherally enhancing epidural fluid collection at T9-T10.
Imaging isolates the mechanical cause of the spinal cord compression.
3
Determine the definitive intervention.
Emergent surgical decompression (laminectomy) must be selected.
Mechanical compression with advancing neurologic deficits requires immediate surgical relief to prevent permanent ischemic injury to the spinal cord.

Anahtar Kavram

Management of spinal epidural abscess with acute neurologic deficits
Tahmini Süre:1m 15s
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Konular

Neurosurgery

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