Although rare in children, spinal epidural abscess (SEA) is a rapidly progressive clinical entity that can lead to irreversible neurologic damage if untreated. The rarity and variability in presentation can lead to initial misdiagnosis. Diagnosis requires a high index of suspicion and is often delayed until neurologic deficits are present.
Our recent issue Pediatric Spinal Epidural Abscess: Recognition and Management in the Emergency Department reviews key findings on the history and physical examination that are associated with SEA, provides guidance for the laboratory tests and imaging studies that are indicated once SEA is suspected, and discusses treatment options based on current evidence.
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Here are a few key points:
- Fever, back pain, and neurologic symptoms are the classic triad of a spinal epidural abscess (SEA), but this presentation is seen in <10% of cases. Young children may present with variable symptoms such as abdominal pain or failure to bear weight.
- Neurologic deficits are an indicator of severe, progressed disease, but they may not be present in the early stages. Lack of neurologic symptoms does not rule out SEA.
- SEA has a very rapid progression of disease. Patients can progress rapidly from a normal neurologic examination to signs of paralysis within 12 to 48 hours.