title: [Spinal epidural abscess with persistent increase in cerebrospinal fluid protein: a case study].
abstract: A 67-year-old man under hemodialysis treatment developed neck stiffness, fever and conscious disturbances. The patient was infected with Methicilin-resistant Staphylococcus aureus (MRSA) sepsis caused by an infection on a dialysis shunt. On admission, he was diagnosed with bacterial meningoencephalitis and underwent a series of antibiotic chemotherapies. The treatment brought cell count in the cerebrospinal fluid to a subnormal level but his clinical status did not improve. The patient continued to have high level of cerebrospinal fluid protein (898 mg/dl). Cervical MRI demonstrated two abscesses deep in the neck as well as in the epidural region of the cervical spinal cord, from C2 to C5 vertebral levels. Based on these findings, spinal epidural abscess (SEA) was diagnosed. Intensive antibiotic chemotherapy especially targeted for MRSA could eradicate abscesses and improve clinical status. However, persistent high protein level in the cerebrospinal fluid could suggest SEA.
authors.affiliation: Department of Neurology, Neurological Institute, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Mitsuhashi
authors.forename: Tomomi
authors.initials: T
authors.lastname: Nakamura
authors.forename: Shiori
authors.initials: S
authors.lastname: Hashimoto
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Uchiyama
authors.forename: Makoto
authors.initials: M
authors.lastname: Iwata
mesh_terms: D000368:Aged; D002556:Cerebrospinal Fluid Proteins / Q000134:cerebrospinal fluid*; D020802:Epidural Abscess / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000382:microbiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016106:Methicillin Resistance; D006435:Renal Dialysis; D013203:Staphylococcal Infections / Q000134:cerebrospinal fluid*; D013211:Staphylococcus aureus / Q000187:drug effects*; D014057:Tomography, X-Ray Computed
chemical_list: D002556:Cerebrospinal Fluid Proteins