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Epidural Abscess — FRCA Final MCQ

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HardRegional AnaesthesiaEpidural AbscessFRCA Final

A 48-year-old woman has a thoracic epidural catheter at T8/9 for analgesia after open cholecystectomy. On postoperative day 2 she develops a temperature of 38.9°C, focal back pain and tenderness at the epidural insertion site, and progressive bilateral leg weakness. The epidural infusion is stopped, but urgent examination 60 minutes later confirms persistent 3/5 power in both legs and a new sensory level. Which investigation should be arranged immediately?

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Correct answer: A — Obtain an urgent contrast-enhanced MRI of the spine

Fever, focal spinal pain and persistent new neurological deficit after epidural analgesia indicate a possible spinal epidural abscess or other compressive vertebral-canal lesion. **Urgent contrast-enhanced MRI of the spine** is the investigation of choice because it identifies the level, extent and neural compression and permits immediate spinal-surgical planning. Anaesthetic and spinal/neurosurgical teams should be contacted concurrently; blood cultures and empirical intravenous antibiotics should follow promptly without delaying imaging. Catheter removal and tip culture may contribute microbiological information but cannot exclude or localise an abscess. Antibiotics with observation alone are unsafe in a patient with neurological impairment. CT is less sensitive and is reserved principally for situations in which MRI cannot be performed. Lumbar puncture does not diagnose an epidural collection reliably and may be hazardous when spinal canal compression is suspected.

Reference: Bond A, Manian FA. Evaluation and management of spinal epidural abscess. Current Emergency and Hospital Medicine Reports. 2015. https://pubmed.ncbi.nlm.nih.gov/26540492/