Spinal epidural abscesses account for 1 or 2 of every 10,000 hospital admissions, Staphylococcus aureus being the bacterium most frequently involved. Brucellosis is a disorder of worldwide distribution, relatively frequent in South America and in Mediterranean countries in Europe and Africa. Whilst in the USA only 200 cases are reported every year, in Spain it is the most frequent zoonosis. This systemic disease seldom produces spondylodiscitis which in a minority of cases may be complicated by spinal epidural abscesses, in general of lumbar location. The purpose of this article is to analyse 4 cases of brucellar spinal epidural abscess of cervical location and diagnosed in the Province of Teruel, Spain, an endemic area for the disease, through 10 consecutive years (1990–1999). We consider noteworthy the following facts: the first case was a technical employee who acquired the infection in our laboratory of microbiology, the second presented with an extensive purulent collection invading prevertebral and retropharyngeal regions, the third case was cured only with antibiotics without residual deficits. In the fourth case we were not able to demonstrate spondylodiscitis accompanying the epidural abscess at the C2–C6 levels. We discuss especially the epidemiological aspects of brucellosis, the existence of epidural abscess without spondylodiscitis, the clinical manifestations, the diagnosis by means of magnetic resonance imaging, specific serological tests for Brucella, antibiotic treatment and the prognosis of our cases.

Chang CZ, Huang TY, Howng SL: Spinal epidural abscess: A case report. Kao Hsiung I Hsueh Tsa Chi 1997;13:457–461.
Hlavin ML, Kaminski HJ, Ross JG, Ganz E: Spinal epidural abscess: A ten years perspective. Neurosurgery 1990;27:177–184.
Tacconi L, Johnston FG, Symon L: Spinal epidural abscess, review of 10 cases. Acta Neurochir (Wien) 1996;138:520–523.
Colle I, Peeters P, Le Roy I, Diltoer M, D’Haens J: Epidural abscess: Case report and review of the literature. Acta Clin Belg 1996;51:412–416.
Nussbaum ES, Rigamonti D, Standiford H, Numaguchi Y, Wolf AL, Robinson WL: Spinal epidural abscess: A report of 40 cases and review. Surg Neurol 1992;38:225–231.
Widovszky T: Spinalis epiduralis abscessus. Orvosi Hetilap 1995;136:1769–1775.
Küker W, Mull M, Mayfrank L, Töpper R, Thron A: Epidural spinal infection: Variability of clinical and magnetic resonance imaging finding. Spine 1996;22:544–551.
Giuffrida S, Charamonte I, Saponara R, Geco S, Giamonna G: Cervical epidural abscess: Serial MRI study. J Neurosurg Sci 1997;42:219–223.
Friedman DP, Hills JR: Cervical epidural spinal infection: MR imaging characteristics. Am J Roentgenol 1994;163:699–704.
Gobierno de Aragón: Boletin epidemiológico de Aragón 1999;136:1211–1218.
Colmenero JD, Cisneros JM, Orjuela DL, Pachón J, García-Portales R, Rodríguez-San Pedro P, Juárez C: Clinical course and prognosis of brucella-spondylitis. Infection 1992;20:38–42.
Pina MA, Ara JR, Modrego PJ, Juyol MC, Capablo JL: Brucellar spinal epidural abscess. Eur J Neurol 1999;6:87–89.
Ariza-Cardenal J: Brucelosis; in Farreras-Valenti P, Rozman C (eds): Medicina interna. Madrid, Marby/Doyma, 1995, pp 2312–2317.
Scuccimarra A, Russo A, Cafarelli F, Scaffidi G, D’Ascoli G: Abcès extradural lombaire mélitococcique sans spondylite: à propos d’un cas. Neurochirurgie 1987;33:71–73.
Ariza J: Brucelosis; in Farreras-Valenti P, Rozman C (eds): Medicina interna. Barcelona, Doyma, 1992, pp 2253–2258.
García-Gómez T: Neurobrucelosis, formas clínicas; in Blázquez-Menes B (ed): Infecciones bacterianas crónicas del sistema nervioso. Sociedad Española de Neurología. Barcelona, MCR, 1987, pp 165–168.
González-García J, Gelabert M, Bandin J, Villa JM, Pravos AG: Absceso epidural cervical como causa de tetraparesia. Rev Neurol 1999;29:727–730.
Akagi S, Shimada H, Kato I, Saito T, Ogawa R: Cervical spondylitis and epidural abscess caused by Salmonella enteritidis with tetraplegia. Spine 1998;23:2701–2712.
Gutiérrez Altes A, Pena-García P: Neurobrucelosis: diagnóstico de laboratorio; in Blázquez-Menes B (ed): Infecciones bacterianas crónicas del sistema nervioso. Sociadad Española de Neurologia. Barcelona, MCR, 1987, pp 169–173.
Guridi J, Gil JL, Ollier J, Uríz J, Aguilera E: Abscesos epidurales espinales. Tratamiento conservador. A propósito de 3 casos. Neurología 1993;8:152–155.
Díaz-Guzmán J, García-Escrig M, Soto O: Absceso epidural masivo: evolución clinicorradiológica con tratamiento no quirúrgico. Neurología 1994;9:32–33.
Wu LL, Chen ST, Tang LM: Nonsurgical treatment of spinal epidural abscess: Report of a case. J Formos Med Assoc 1994;93:253–255.
Hanigan WC, Asner NG, Elwood PW: Magnetic resonance imaging and the nonoperative treatment of spinal epidural abscess. Surg Neurol 1990;34:408–413.
Geijo-Martinez P, Pérez-Gil MA, Ruiz-Ribo D, Arranz-García G, Santiago-Herrando M: Espondilitis brucelar con absceso epidural curada con tratamiento médico. Ann Med Interna 1996;13:203–204.
Hernández MA, Frank A, Barreiro P, Anciones B, Díez-Tejedor C: Tratamiento de la neurobrucelosis; in Blázquez-Menes B (ed): Infecciones bacterianas crónicas del sistema nervioso. Sociedad Española de Neurología. Barcelona, MCR, 1987, pp 187–196.
Mousa AM, Bahar RH, Araj GF, Koshy TS, Muhtaseb SA, al-Mudallal DS, Marafie AA: Neurological complications of brucella spondylitis. Acta Neurol Scand 1990;81:16–23.
McLean DR, Rusell N, Khan MY: Neurobrucellosis: Clinical and therapeutic features. Clin Infect Dis 1992;15:582–590.
Romero M, Sánchez F, Fernández-Bolaños R, Jiménez MD: Neuritis óptica como manifestación clínica de neurobrucelosis. Rev Neurol 1999;28:438.
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