Naše iskustvo u dijagnostici spinalnog epiduralnog apscesa upotrebom novih dijagnostičkih metoda - kompjutorizirane tomografije i magnetske rezonancije
| Autor: | Anka Aleksić-Shihabi, Sandra Celić, Blanša Bilić, Vlatko Knežević |
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| Jazyk: | angličtina |
| Rok vydání: | 2009 |
| Předmět: | |
| Zdroj: | Acta clinica Croatica Volume 48 Issue 2 |
| ISSN: | 1333-9451 0353-9466 |
| Popis: | A 69-year-old woman, a diabetic, presented to emergency unit for severe back pain that occurred three weeks of her having sustained a fall and blow in the back. Upon admission, she developed elevated body temperature, urinary retention and severe paraparesis of lower extremities. Laboratory testing showed increased levels of erythrocyte sedimentation rate (93 mm/h), leukocyte count (18.3x103/ mL), C-reactive protein (246.5 mg/L) and liver enzymes, and abundant bacteria in urine sediment. Penicillin-resistant Staphylococcus aureus was isolated in blood culture. Antibiotic therapy according to the antibiotic sensitivity report was introduced. Magnetic resonance of thoracic spine revealed epidural liquid collection compressing the spinal medulla from Th2 to Th7. The patient was transferred to neurosurgery for posterior laminectomy and decompression, along with antibiotic therapy. Microbiology confirmed Staphylococcus aureus in the intraoperative tissue specimen. The patient was discharged from the hospital with mild paraparesis and continuing antibiotic therapy recommended. Bolesnica u dobi od 69 godina sa šećernom bolešću javila se na hitnu pomoć zbog jakih bolova u leđima tri tjedna nakon pada i udarca u leđa. Kod prijma je zabilježena visoka temperatura, zadržavanje mokraće i teška parapareza donjih udova. Laboratorijski nalazi su pokazali povišene vrijednosti sedimentacije (93 mm/h), leukocita (18,3x10³/µL), C-reaktivnog proteina (246,5 mg/L), jetrenih enzima te dosta bakterija u mokraći. Iz kemokulture izoliran je Staphylococcus aureus rezistentan na penicilin pa je bolesnici uvedena antibiotska terapija prema antibiogramu. Magnetska rezonancija torakalne kralježnice pokazala je epiduralnu nakupinu tekućeg sadržaja koji je izazivao pritisak na medulu spinalis od Th2 do Th7. Na neurokirurgiji je izvedena stražnja laminektomija i dekompresija te je nastavljena antibiotska terapija. Mikrobiološka analiza operacijskog uzorka potvrdila je Staphylococcus aureus. Bolesnica je otpuštena u poboljšanom stanju, s blagom paraparezom i preporukom za daljnju antibiotsku terapiju. |
| Databáze: | OpenAIRE |
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