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Spinal Infections: Understanding Meningitis & Epidural Abscess


What is Meningitis?

Meningitis is an inflammation of the fluid and three membranes (meninges) surrounding the brain and spinal cord. It can be caused by viral, bacterial, or fungal infections and requires emergency treatment. Symptoms include a stiff neck, headaches, and drowsiness.Causes of MeningitisThe most common causes are viral and bacterial infections, but other factors include:

  • Cancer
  • Fungi
  • Drug-induced reactions
Some forms of meningitis are contagious, spreading through coughing, sneezing, or close contact. The infection reaches the brain or spinal cord through the bloodstream, nerve endings, or reactivation in the nervous system. Non-infectious meningitis, however, occurs due to physical injury or other conditions.

Symptoms of Meningitis

Viral and bacterial meningitis have similar initial symptoms, though bacterial meningitis is more severe.

Viral Meningitis Symptoms:

  • Fever
  • Headaches
  • Stiff neck
  • Seizures
  • Sensitivity to light
  • Sleepiness
  • Nausea, vomiting, and decreased appetite
Bacterial Meningitis Symptoms:
  • Altered mental state
  • Nausea and vomiting
  • Sensitivity to light
  • Headache and fever
  • Chills
  • Stiff neck
  • Purple skin patches resembling bruises
Diagnosis of Meningitis

Doctors diagnose meningitis through:

  • Blood Cultures: Identify bacteria traveling from the blood to the brain.
  • Complete Blood Count (CBC): Measures white blood cells, which fight infections.
  • Chest X-rays: Reveal pneumonia, tuberculosis, or fungal infections that may lead to meningitis.
  • CT Scans: Detect brain abscesses or intracranial pressure.
Prevention of Meningitis

To reduce the risk of infection:

  • Get enough rest
  • Avoid smoking
  • Wash hands frequently
  • Limit contact with sick individuals
Complications of Meningitis

Meningitis can lead to severe complications, including:

  • Seizures
  • Hearing or vision loss
  • Brain damage
  • Hydrocephalus (fluid buildup in the brain)
  • Blood infections causing gangrene or organ damage
Spinal Epidural Abscess

A spinal epidural abscess is an infection in the epidural space between the spinal dura mater and the vertebral periosteum. It can cause severe neurological deterioration and requires immediate medical attention.Risk Factors for Spinal Epidural Abscess

  • Comorbidities: Diabetes, alcohol abuse, HIV
  • Spinal Conditions: Degenerative joint disease, trauma, surgery
  • Infections: Intravenous drug use, local infections
Symptoms of Spinal Epidural Abscess
  • Severe back pain
  • Fever
  • Radiculopathy (pain radiating from the spine)
Causes of Spinal Epidural Abscess

Bacteria reach the epidural space through:

  • Hematogenous Spread: Infection from other body parts enters the bloodstream.
  • Direct Invasion: Nearby infections, such as discitis or osteomyelitis, spreading to the spine.
  • Iatrogenic Causes: Injections, spinal anesthesia, or surgical procedures.
Treatment and Management

The preferred treatment is surgical drainage combined with systemic antibiotics. Emergency decompressive laminectomy and debridement should be performed early.

Physiotherapy treatments include:

  • Myofascial Release
  • IASTM
  • Manual Therapy
  • Dry Needling
  • Kinesiology Taping
Surgical Approaches:
  • Laminotomy (for children)
  • Spinal Instrumentation (for stability after surgery)
Antibiotic Treatments:
  • Staphylococci: Penicillin, first- or second-generation cephalosporins
  • MRSA: Vancomycin
  • Gram-negative Bacilli: Third- or fourth-generation cephalosporins
Medical Management

Medical management is considered if:

  • The patient has minimal neurological deficits.
  • The causative organism is identified through blood culture or CT-guided aspiration.
  • The patient is closely monitored.
However, medical management alone has a 40% failure rate, leading to permanent paralysis or even death in severe cases. The standard antibiotic duration is 4 to 8 weeks, with intravenous therapy recommended for effectiveness.

Risk Factors for Failed Treatment

  • Neurological deficits
  • Age over 65
  • Diabetes
Differential Diagnoses
  • Disc prolapse
  • Spinal canal stenosis
  • Vertebral discitis and osteomyelitis
  • Transverse myelitis
  • Spinal cord hematoma
  • Psoas abscess
  • Meningitis
  • Urinary tract infection
  • Endocarditis
Conclusion

Meningitis and spinal epidural abscesses are severe spinal infections that require early diagnosis and aggressive treatment. Awareness of symptoms, preventive measures, and prompt medical intervention can significantly improve outcomes and reduce complications.