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A Lethal Sequelae of Spinal Infection Complicating Surgery and Radiotherapy for Head and Neck Cancer.

Cheung JP, Mak KC, Tsang HH, Luk KD - Asian Spine J (2015)

Bottom Line: This report discusses the serious consequences of a missed cervical spine infection including cerebrospinal fluid fistula formation and persistent central nervous system infection, and serves as a reminder to clinicians of the possible association between cervical spine infections and prior head and neck surgery and radiotherapy.In all such cases, the posterior pharyngeal wall should be inspected during follow-up.Despite the appearance of an intracranial infection, the cervical spine should be investigated, especially if the response to appropriate antibiotics is suboptimal.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.

ABSTRACT
Patients who have undergone neck dissection and radiotherapy are at risk of cervical spine infections. Furthermore, previous radiotherapy and cervical spine infections can lead to fistula formation to the subarachnoid space and intracranial infection. This report discusses the serious consequences of a missed cervical spine infection including cerebrospinal fluid fistula formation and persistent central nervous system infection, and serves as a reminder to clinicians of the possible association between cervical spine infections and prior head and neck surgery and radiotherapy. In all such cases, the posterior pharyngeal wall should be inspected during follow-up. Despite the appearance of an intracranial infection, the cervical spine should be investigated, especially if the response to appropriate antibiotics is suboptimal.

No MeSH data available.


Related in: MedlinePlus

(A) Axial magnetic resonance imaging (MRI) T1 contrast image showing the C3-C4 cerebrospinal fluid fistula (red arrow) to the subarachnoid space. (B) Sagittal MRI T1 contrast image showing the C3-C4 spondylodiscitis (white arrow).
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Figure 2: (A) Axial magnetic resonance imaging (MRI) T1 contrast image showing the C3-C4 cerebrospinal fluid fistula (red arrow) to the subarachnoid space. (B) Sagittal MRI T1 contrast image showing the C3-C4 spondylodiscitis (white arrow).

Mentions: Four weeks after the complete cessation of antibiotics, he developed dizziness and nystagmus in right horizontal gaze. Brain computed tomography (CT) (Fig. 1) showed a small right caudate and cerebellar infarct and loculated air densities at the interhemispheric fissure, left Sylvian fissure, interpeduncular cistern, left ambient cistern, and pericallosal region. In view of the new clinical and imaging findings and his history of head and neck cancers, neck MRI was performed to investigate the source of the infection and pneumocephalus. MRI (Fig. 2) revealed C3-C4 spondylodiscitis and a CSF fistula to the subarachnoid space, and CT myelography (Fig. 3) demonstrated the site of CSF leakage through the dura at the level of the C3-C4 disc. Vancomycin, cefepime, and metronidazole were started after consultation with a microbiologist.


A Lethal Sequelae of Spinal Infection Complicating Surgery and Radiotherapy for Head and Neck Cancer.

Cheung JP, Mak KC, Tsang HH, Luk KD - Asian Spine J (2015)

(A) Axial magnetic resonance imaging (MRI) T1 contrast image showing the C3-C4 cerebrospinal fluid fistula (red arrow) to the subarachnoid space. (B) Sagittal MRI T1 contrast image showing the C3-C4 spondylodiscitis (white arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4522455&req=5

Figure 2: (A) Axial magnetic resonance imaging (MRI) T1 contrast image showing the C3-C4 cerebrospinal fluid fistula (red arrow) to the subarachnoid space. (B) Sagittal MRI T1 contrast image showing the C3-C4 spondylodiscitis (white arrow).
Mentions: Four weeks after the complete cessation of antibiotics, he developed dizziness and nystagmus in right horizontal gaze. Brain computed tomography (CT) (Fig. 1) showed a small right caudate and cerebellar infarct and loculated air densities at the interhemispheric fissure, left Sylvian fissure, interpeduncular cistern, left ambient cistern, and pericallosal region. In view of the new clinical and imaging findings and his history of head and neck cancers, neck MRI was performed to investigate the source of the infection and pneumocephalus. MRI (Fig. 2) revealed C3-C4 spondylodiscitis and a CSF fistula to the subarachnoid space, and CT myelography (Fig. 3) demonstrated the site of CSF leakage through the dura at the level of the C3-C4 disc. Vancomycin, cefepime, and metronidazole were started after consultation with a microbiologist.

Bottom Line: This report discusses the serious consequences of a missed cervical spine infection including cerebrospinal fluid fistula formation and persistent central nervous system infection, and serves as a reminder to clinicians of the possible association between cervical spine infections and prior head and neck surgery and radiotherapy.In all such cases, the posterior pharyngeal wall should be inspected during follow-up.Despite the appearance of an intracranial infection, the cervical spine should be investigated, especially if the response to appropriate antibiotics is suboptimal.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China.

ABSTRACT
Patients who have undergone neck dissection and radiotherapy are at risk of cervical spine infections. Furthermore, previous radiotherapy and cervical spine infections can lead to fistula formation to the subarachnoid space and intracranial infection. This report discusses the serious consequences of a missed cervical spine infection including cerebrospinal fluid fistula formation and persistent central nervous system infection, and serves as a reminder to clinicians of the possible association between cervical spine infections and prior head and neck surgery and radiotherapy. In all such cases, the posterior pharyngeal wall should be inspected during follow-up. Despite the appearance of an intracranial infection, the cervical spine should be investigated, especially if the response to appropriate antibiotics is suboptimal.

No MeSH data available.


Related in: MedlinePlus