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Case Reports
. 2024 May;24(3):100214.
doi: 10.1016/j.clinme.2024.100214. Epub 2024 May 4.

A case of spinal epidural abscess concealed by delirium in a young man

Benjamin Page  1 , Sam Waddy  2
Affiliations
Case Reports

A case of spinal epidural abscess concealed by delirium in a young man

Benjamin Page et al. Clin Med (Lond). 2024 May.

Abstract

Spinal epidural abscess is a rare but serious condition with poor outcomes. It's classic triad of new back pain, neurological deficit and fever is only present in 15% of cases at presentation and is initially misdiagnosed in 75-89%.6,7 Delaying treatment is associated with worse outcomes. Delirium is itself a risk factor for mortality but the disturbance in cognition and memory can also complicate clinical assessment.1-5 We present a case of delirium caused by, and obscuring, a spinal epidural abscess. This case highlights the difficulties in diagnosing spinal epidural abscesses, the need for a high index of suspicion for the condition and timely action to minimise morbidity. In addition, it demonstrates the value of treating unexplained delirium as an emergency and the danger of diagnostic premature closure. Finally, the importance of persistent clinical examination of the confused and non-cooperative patient.

Keywords: Abscess; Confusion; Delirium; Infection; Spinal; Weakness.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1
Fig. 1
This sagittal T2 image shows the epidural collection ventral to the cauda equina at L5 level.
See this image and copyright information in PMC

References

    1. Engel G, Delirium Romano J. A syndrome of cerebral insufficiency. J Chronic Dis. 1959;9(3):260–277. - PubMed
    1. Lin S, Liu C, Wang C, et al. The impact of delirium on the survival of mechanically ventilated patients. Crit Care Med. 2004;32(11):2254–2259. - PubMed
    1. Fields S. Review: delirium predicts 12-month mortality independent of dementia status. ACP J Club. 2003;139(3):80. - PubMed
    1. Han J, Shintani A, Eden S, et al. Delirium in the emergency department: an independent predictor of death within 6 months. Ann Emerg Med. 2010;56(3):244–252. - PMC - PubMed
    1. Pisani M, Kong S, Kasl S, Murphy T, Araujo K, Van Ness P. Days of delirium are associated with 1-year mortality in an older intensive care unit population. Am J Respir Crit Care Med. 2009;180(11):1092–1097. - PMC - PubMed

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