Spontaneous lumbar intraspinal subdural abscess: a case report.

BACKGROUND: Subdural spinous abscess is a rare pathology that carries significant morbidity if not diagnosed and treated early; of the cases reported in the literature, very few are genuinely spontaneous in nature. CASE PRESENTATION: Here we demonstrate the case of an otherwise entirely fit and well 56-year-old White, British female presenting with low back pain, bilateral sciatica and sensate urinary retention; lumbar subdural spinous abscess was diagnosed on urgent magnetic resonance imaging and the patient was successfully managed with surgical evacuation and prolonged antibiotic therapy. The patient made a full neurological recovery and was followed-up in the outpatient setting 12 weeks following her initial surgery; she was pain free with normal inflammatory markers and a normal neurological examination. There have been no further consultations and a telephone call at 20 weeks confirmed that she remains well. CONCLUSIONS: This is the second case reported in the literature of a genuinely spontaneous subdural spinous abscess, which was successfully managed with surgical evacuation following prompt diagnosis. This highlights the need to ensure infective pathologies are kept at the back of one's mind even in the most unlikely circumstances, and that excellent outcomes can be achieved with early surgical intervention.

Challenges facing a woman wishing to report intimate partner violence in Belize.

We present a case of a 29-year-old woman who presented to a volunteer-run primary care facility in Southern Belize. Her initial presentation was vaginal itching and white discharge; she also requested insertion of a sub-dermal contraceptive implant. During the insertion, marks suspicious for deliberate self-harm were noticed on the patient's arm, and on further exploration she revealed she was being physically and emotionally abused by her husband. With some encouragement, she requested help in taking further action to preserve her safety; however, in Belize clinicians have no power to assist in cases involving adults. Therefore, the victim should self-present to a police station, resulting in a significant potential barrier to reporting intimate partner violence (IPV). Here we discuss this barrier further, as well as other barriers that exist to reporting IPV, and discuss possible policy changes that may improve the situation in Belize.