[Stellate ganglion blocks as the suspected route of infection in a case of cervical epidural abscess].
Spinal epidural abscess is a comparatively rare disease. Its prognosis reportedly depends on degree and duration of the neurological symptoms before the treatment. Thus, the importance of early diagnosis and prompt surgical treatment has been emphasized repeatedly. In the case reported here stellate ganglion blocks were considered to be involved in the etiology of a cervical epidural abscess. <Case> The 47-year old woman complained of tinnitus and vertigo and repeatedly underwent stellate ganglion blocks over a period of 10 months. In August, 1991, the patient complained of back pain and developed fever. A few days later she noticed motor weakness and sensory disturbances in the legs. Ten days after the onset of these neurological symptoms she complained of rapidly progressive tetraplegia and was referred to this hospital for admission. On admission, she was fully conscious but febrile. Neurologically, she presented tetraplegia, hypesthesia below level of C7 and slight cervical rigidity. Bladder and bowel dysfunction were also observed. MRI examination showed an epidural mass behind vertebral bodies C6-7 compressing the spinal cord. Antibiotic therapy was initiated immediately and emergency surgical decompression was performed through an anterior approach. Intraoperative findings showed a discitis and yellowish liquid pus in the epidural space. Culture of the pus revealed staphylococcus aureus. In this case repeated stellate ganglion blocks before onset of the symptoms were the suspected route of infection. Postoperative MR images confirmed satisfactory decompression of the spinal cord and motor power was gradually recovered after surgery. Approximately 4 months after surgery she could walk independently. Cervical epidural abscess has been rarely reported as a complication of stellate ganglion block.(ABSTRACT TRUNCATED AT 250 WORDS)
Makiuchi
T
T
Department of Neurosurgery, National Medical Center.
Kondo
T
T
Yamakawa
K
K
Shinoura
N
N
Yatsushiro
K
K
Ichi
S
S
Yoshioka
M
M
D000038:Abscess / Q000209:etiology*; D001340:Autonomic Nerve Block / Q000009:adverse effects*; D002574:Cervical Vertebrae; D004824:Epidural Space; D005260:Female; D006801:Humans; D008875:Middle Aged; D013122:Spinal Diseases / Q000209:etiology; D013203:Staphylococcal Infections / Q000209:etiology; D013211:Staphylococcus aureus; D013233:Stellate Ganglion