====== Spinal epidural abscess clinical features ======

Should be considered in a [[patient]] with [[back pain]], [[fever]], and [[spine tenderness]]

[[Spinal epidural abscess]] usually presents with excruciating pain localized over [[spine]] with [[tenderness]] to percussion.

[[Radicular]] symptoms follow with subsequent distal [[cord]] findings, often beginning with [[bowel]]/[[bladder]] disturbance, abdominal distension, [[weakness]] progressing to para- and [[quadriplegia]]. Average time is 3 days from back pain to root symptoms; 4.5 days from root pain to weakness; 24 hrs from [[weakness]] to [[paraplegia]].

Fever, sweats or rigors are common, but are not always present
((Curry WT,Jr, Hoh BL, Amin-Hanjani S, et al. Spinal
epidural abscess: clinical presentation, management,
and outcome. Surg Neurol. 2005; 63:364–
71; discussion 371)).

A furuncle (skin boil) somewhere on the body may be identified in 15%.

Patients may be encephalopathic. This may range from mild to severe and may further delay diagnosis.
Meningismus with a positive Kernig sign may occur.

Patients with postoperative SEA may demonstrate surprisingly few signs or symptoms (including
lack of leukocytosis, lack of fever) aside from local pain
((Spiegelmann R, Findler G, Faibel M, et al.
Postoperative Spinal Epidural Empyema: Clinical
and Computed Tomography Features. Spine. 1991;
16:1146–1149))
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Clinical signs, duration of symptoms and the rate of neurological deterioration show a high inter-individual variability, and the classic triad (spinal pain, fever and neurological deficit) is often not found, especially not at first presentation to a physician. However, most patients complain of severe localized back pain. 
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In a study from 34 patients only three (42.9%) of the seven patients who died or acquired plegia presented with the three-symptom of [[spinal epidural abscess clinical features]] classic triad of fever, neurologic symptoms, and neck or back pain.
((King C, Fisher C, Brown PCM, Priest KC, Tanski M, Sullivan P.
Time-to-completed-imaging, survival and function in patients with spinal epidural
abscess: Description of a series of 34 patients, 2015-2018. BMC Health Serv Res. 
2020 Feb 14;20(1):119. doi: 10.1186/s12913-020-4973-5. PubMed PMID: 32059715;
PubMed Central PMCID: PMC7023770.
)).