Volume 1, Issue 3 (12-2015)                   IrJNS 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. IrJNS. 2015; 1 (3) :33-34
URL: http://irjns.org/article-1-23-en.html
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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.
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).
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

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  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

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