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July 1962

Extrathecal and Intrathecal Suppuration: Report of Two Cases and Discussion of the Spinal Subdural Space

Author Affiliations

Present address of Dr. Shadle: Long Beach, Calif.; From the Departments of Neurology and Medicine, Permanente Medical Group, Kaiser Foundation Hospital.

Arch Neurol. 1962;7(1):33-36. doi:10.1001/archneur.1962.04210010039003

Intraspinal abscess, its initial symptoms being low-back pain and sciatica, has been mistaken for a spinal-disk herniation—an error that may result in permanent paraplegia. If that complication is to be averted, such an abscess must be promptly subjected to surgical correction, which is often followed by recovery. The subject brings up for discussion the somewhat dubious concept of a spinal subdural space, hence, the term, "subdural abscess."

Extrathecal abscesses are more common than intrathecal loculations of pus. There is a considerable literature regarding the former: Dandy1 collected 25 cases in 1926; Rankin and Flothow,2 225 in 1946; Heusner,3 an additional 20 in 1948; Hulme and Dott,4 another 25 in 1954. "Boils and pimples" were the etiologic factor in an unexpected one-third of Hulme and Dott's series. The symptoms are aching of the spine, root pains, headache, and neck stiffness, followed eventually in some instances by rapidly

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