Volume 1, Issue 3 (12-2015)                   Iran J Neurosurg 2015, 1(3): 33-34 | Back to browse issues page


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Guillermo Calderon-Miranda W, Escobar Hernandez N, Rafael Moscote Salazar L. A Brief Reprt of Polymicrobial Osteomyelitis of Odontoid Process with Epidural Abscess. Iran J Neurosurg. 2015; 1 (3) :33-34
URL: http://irjns.org/article-1-23-en.html
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Introduction
Osteomyelitis of the odontoid process associated with epidural abscess is a rare clinical entity characterized by the presence of inflammatory and infectious paranasal or near process with intracranial extension. The existence of predisposing factors for becoming immunocompromised such as diabetes mellitus, HIV infection and steroid use are common.
Case Presentation
A 55-year-old male patient consuming hallucinogenic drugs (cocaine, marijuana) by inhalation, who developed pain and neck stiffness was studied. He was treated with anti-inflammatory and analgesic for 25 days, but for worsening symptoms he had been refereed to our institution, presenting hallucinations and dysarthria. A physical assessment was central glucose of 851 mg/dl and deterioration of neurological status, which required mechanical ventilatory support. MRI of the junction craniovertebral showed a hyperdense epidural mass and presence of air and left odontoid subluxation with Grisel syndrome secondary to inflammation in the parapharyngeal area. Chest radiography showed left pneumothorax of approximately 80%, which was successfully managed with chest tube. MRI with gadolinium showed the craniovertebral epidural abscess around the odontoid process without compression and parafacetario cervicomedullary abscess on the left side of verterbral bodies C2-C3 (Figure 1 A, B, C).
In the cerebrospinal fluid culture a methicillin-sensitive Staphylococcus aureus and Streptococcus mitis were isolated, treated with ceftriaxone, and metronidazole-dicloxacillin. On the seventh day of stay in critical care unit, successful extubation was achieved. He recovered from mild neck stiffness after completing antibiotic therapy.
Discussion
Osteomyelitis of the odontoid process is very rare and therefore requires a high degree of clinical suspicion for diagnosis (2-4). The diagnosis requires a careful assessment of history, comorbid conditions, laboratory tests and imaging. Late diagnosis can lead to poor prognosis. MRI is the first imaging modality. The occipitocervical immobilization, broad-spectrum antibiotic therapy and surgical stabilization in selected cases are the foundations of treatment (5,6).
Conclusion
Osteomyelitis of the odontoid process is an entity of difficult diagnosis that may prove catastrophic when accompanied by epidural abscess. Our patient had a satisfactory condition, demonstrating the beneficial effect of directed antibiotic treatment.

References
  1. Kaufmann DM, Kaplan JG, Litman N Infectious agents in spinal epidural abscesses . Neurology 1980. 30: 844-850
  2. Haridas A, Walsh DC, Mowle DH. Polymicrobial Osteomyelitis of the Odontoid Process with Epidural Abscess: Case Report and Review of Literature. Skull Base. 2003 May;13(2):107-111.
  3. Kubo S, Takimoto H, Hosoi K, Toyota S, Karasawa J, Yoshimine T. Osteomyelitis of the odontoid process associated with meningitis and retropharyngeal abscess--case report. Neurol Med Chir (Tokyo). 2002 Oct;42(10):447-51.
  4. Wiedau-Pazos M, Curio G, Grüsser C. Epidural abscess of the cervical spine with osteomyelitis of the odontoid process. Spine (Phila Pa 1976). 1999 Jan 15;24(2):133.
  5. Willenborg KM, Stöver T, Becker H, Krauss JK, Lenarz T. Parapharyngeal abscess and osteomyelitic destruction of the odontoid process. Laryngorhinootologie. 2007 Feb;86(2):128-30.
  6. Young WF, Weaver M. Isolated pyogenic osteomyelitis of the odontoid process. Scand J Infect Dis. 1999;31(5):512-5. Review.
  7. directed antibiotic treatment.
Type of Study: Case report | Subject: Gamma Knife Radiosurgery
* Corresponding Author Address: * Corresponding Author Address: Department of Neurosurgery, Red Latino, Latin American Trauma and Intensive Neuro-Care Organization, Bogota, Colombia. E-mail: mineurocirujano@aol.com

References
1. Kaufmann DM, Kaplan JG, Litman N Infectious agents in spinal epidural abscesses . Neurology 1980. 30: 844-850 [DOI:10.1212/WNL.30.8.844]
2. Haridas A, Walsh DC, Mowle DH. Polymicrobial Osteomyelitis of the Odontoid Process with Epidural Abscess: Case Report and Review of Literature. Skull Base. 2003 May;13(2):107-111. [DOI:10.1055/s-2003-40601] [PMID] [PMCID]
3. Kubo S, Takimoto H, Hosoi K, Toyota S, Karasawa J, Yoshimine T. Osteomyelitis of the odontoid process associated with meningitis and retropharyngeal abscess--case report. Neurol Med Chir (Tokyo). 2002 Oct;42(10):447-51. [DOI:10.2176/nmc.42.447]
4. Wiedau-Pazos M, Curio G, Grüsser C. Epidural abscess of the cervical spine with osteomyelitis of the odontoid process. Spine (Phila Pa 1976). 1999 Jan 15;24(2):133. [DOI:10.1097/00007632-199901150-00008] [PMID]
5. Willenborg KM, Stöver T, Becker H, Krauss JK, Lenarz T. Parapharyngeal abscess and osteomyelitic destruction of the odontoid process. Laryngorhinootologie. 2007 Feb;86(2):128-30. [DOI:10.1055/s-2006-925284] [PMID]
6. Young WF, Weaver M. Isolated pyogenic osteomyelitis of the odontoid process. Scand J Infect Dis. 1999;31(5):512-5. Review. [DOI:10.1080/00365549950164094] [PMID]
7. directed antibiotic treatment.

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