We are evaluating missed diagnoses of epidural abscesses that lead to quadriplegia, paraplegia, and cauda equina syndrome.

“We are evaluating missed diagnoses of epidural abscesses that lead to quadriplegia, paraplegia, and cauda equina syndrome from emergency rooms across the country. This population requires a low threshold for MRI imaging because of high risk for infection from IV drug abuse and poor medical follow-up” … Greg Vigna, MD, JD, national neurological injury attorney.

Dr. Anthony M. DiGiorgio, from the Department of Neurosurgery at Louisiana State University Medical Center, published an article in Neurosurgical Focus, “The increasing frequency of intravenous drug abuse-associated spinal epidural abscess: a case series” that reviewed the charts of 45 patients with epidural abscess secondary to IV drug abuse over a five-year period ending in 2018. He noted that the trend line of occurrences of spinal epidural abscesses increased yearly during the study period along with the trend line of drug-related deaths in Louisiana.

In the study there was a lower rate of improvement of neurological function which the authors attributed this to delays in getting to the operating room. Dr. DiGiorgio wrote, “Reasons for delays included failure to seek medical attention, noncompliance with physician advice, and comorbidities precluding surgical intervention. Patients who underwent surgery within 24 hours of onset of neurological deficits did have a slightly better chance at recovery of neurological function.”

Dr. DiGiorgio also wrote, “Irrespective of the reason for the increasing rate of IV drug abuse associated spinal epidural abscess remains a significant public health issue.”

“As a physician, I managed the rehabilitation of plenty of paralyzed IV drug abusers who had presented to medical providers with ‘Red Flag Warnings’ of epidural abscess.” — Greg Vigna, MD, JD

Greg Vigna, MD, JD, national pharmaceutical injury attorney, “We are seeing a disturbing trend that physicians, nurse practitioners, and physician assistants, providing care in emergency rooms across the country are not imaging this at-risk group early despite symptoms and signs of spinal epidural abscesses. IV drug abuses are an at-risk population and vulnerable population.”

Dr. Vigna concludes, “As a physician, I managed the rehabilitation of plenty of paralyzed IV drug abusers who had presented to medical providers with ‘Red Flag Warnings’ of epidural abscess only to be turned away without diagnostic testing. This group is vulnerable, at risk of serious infections that may result in paralysis and these patients must be imaged early. The standard of care calls for a low threshold for imaging for IV drug abusers as non-compliance and unreliable medical follow-up is the rule and not the exception.”

Dr. Vigna is a California lawyer who focuses on catastrophic neurological injuries and has a national litigation practice. He is Board Certified Physician in Physical Medicine and Rehabilitation, Certified Life Care Planner, an expert on spinal cord injury, cerebral palsy, cauda equina syndrome, stroke, and traumatic brain injury. Vigna Law Group has a non-exclusive association with Ben Martin Law Group, a Dallas Texas firm. Ben Martin is a national pharmaceutical attorney and personal injury attorney in Dallas, Texas.

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