Ewha Med J.  2024 Oct;47(4):e57. 10.12771/emj.2024.e57.

Septic cerebral embolism following lumbar spine surgery in a 69-year-old man with a lumbar epidural abscess in Korea: a case report

• Lee YS

• KMID: 2561420
• DOI: http://doi.org/10.12771/emj.2024.e57

Abstract

Septic embolism and stroke are serious complications in patients with sepsis and often necessitate urgent surgical intervention to control the source of infection. A 69-year-old man presented with severe pain in his back and left thigh. MRI revealed extensive posterior epidural or subdural abscesses extending from the cervical to the lumbar level, as well as an abscess in the iliopsoas muscle. The patient underwent urgent drainage of the abscesses and decompression of the lumbar spine. Postoperatively, he developed sudden-onset atrial fibrillation and altered mental status. Brain CT showed multiple embolic infarctions. His condition deteriorated due to persistent infection, leading to disseminated intravascular coagulation, acute kidney injury, and septic shock. This case highlights the risk of cerebral embolism and hemorrhagic complications in patients with sepsis who undergo surgery. Early recognition of individuals at high risk and comprehensive perioperative management are critical to reducing the likelihood of such complications.

Keyword

Embolism; Epidural abscess; Intracranial embolism; Multiple organ failure; Sepsis

Figure

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  Fig. 1. Spine MRI revealed a posterior epidural or subdural abscess extending from the cervical to the lumbar level. Additionally, an abscess approximately 7.6 cm in height was identified in the left iliopsoas muscle.

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  Fig. 2. Brain CT revealed multiple bilateral infarctions. On postoperative day 8, the patient developed acute intraventricular hemorrhage in the right lateral ventricle, along with a 4.5-cm intracerebral hemorrhage in the right occipital lobe.

Reference

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