Case Report

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

Yo Seob Lee *
Author Information & Copyright
1Department of Anesthesiology and Pain Medicine, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul 05278, Korea.
*Corresponding Author: Yo Seob Lee, Phone: +82-10-7286-6298. E-mail: lystruth@naver.com.

© Copyright 2024 Ewha Womans University School of Medicine. This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: Aug 31, 2024; Revised: Sep 26, 2024; Accepted: Sep 26, 2024

Published Online: Oct 31, 2024

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. Magnetic resonance imaging revealed extensive posterior epidural or subdural abscesses extending from the cervical to the lumbar level, as well as an abscess in the iliopsoas muscle. Laboratory findings indicated infection. 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 computed tomography showed multiple embolic infarctions. Despite treatment with aspirin, he developed intracerebral hemorrhage on the eighth postoperative day. His condition deteriorated due to persistent infection, leading to disseminated intravascular coagulation, acute kidney injury, and septic shock. The patient died on postoperative day 33. 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. Additionally, vigilant postoperative monitoring of patients with severe sepsis is necessary to improve outcomes.

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