♪ ♪ >> WHEN MOST PEOPLE THINK ABOUT COMPLICATIONS FROM DRUG ABUSE, WE THINK OVERDOSE, NOW ADD TO THAT BRAIN AND SPINAL INFECTIONS.

PLEASE STAY WITH US AS WE DISCUSS CENTRAL NERVOUS SYSTEM INFECTIONS NEXT ON KENTUCKY HEALTH.

DRUG ABUSE IS ASSOCIATED WITH MANY COMPLICATIONS BUT SOCIAL CONSEQUENCES ARE INSIDIOUS AND INCLUDE THE DISRUPTION OF FAMILY UNITS AND THE LOST POTENTIAL OF BOTH YOUNG AND OLDER VICTIMS.

SOME PHYSICAL CONSEQUENCES SUCH AS DEATH FROM RESPIRATORY DEPRESSION ARE IMMEDIATE AND OBVIOUS.

HOWEVER, OTHER CONDITIONS SUCH AS ENDOCARDITIS, ANEURYSMS ARE DIFFICULT TO DIAGNOSE, COSTLY TO TREAT AND DESPITE OF THE BEST EFFORTS MAY RESULT IN THE DEATH OF A PATIENT.

TODAY WE ARE GOING TO TALK ABOUT CENTRAL NERVOUS SYSTEM INFECTIONS FROM ALL CAUSES, BUT ESPECIALLY THOSE RELATED TO DRUG USE.

TRAUMA AND THOSE FROM SEEMINGLY TRIVIAL CONDITIONS SUCH AS SINUS INFECTIONS AND POOR ORAL HEALTH.

OUR GUEST IS Dr. DUANE DENSLER.

Dr. DENSLER IS A GRADUATE IN NASHVILLE.

INTERNSHIP IN GENERAL SURGERY AND NEUROSURGERY AT THE UNIVERSITY OF LOUISVILLE.

CURRENTLY IS IN PRACTICE OF NORTON NUR RAL SCIENCE INSTITUTE.

THANK YOU FOR BEING WITH US.

>> HOW ARE YOU, SIR?

>> I'M OKAY.

IT REALLY IS BRAIN SURGERY.

>> IT REALLY IS, YES, SIR.

>> WE TALK ABOUT DRUG PROBLEMS BUT FEW OF US THINK ABOUT THINGS OUTSIDE OF THE RESPIRATORY DEPRESSION ITSELF PERSON DYING.

BUT CENTRAL NERVOUS SYSTEM INFECTIONS ARE A BIG PROBLEM.

>> VERY SERIOUS, YES, SIR.

WHAT WE HAVE FOUND IN THE LAST 10 TO 12 YEARS IS A SIGNIFICANT INCREASE IN CNS INFECTIONS BOTH IN CRANIAL AND SPINAL RELATED TO I.V.

DRUG USE.

THERE HAS ALWAYS BEEN A NUMBER OF INFECTIONS FROM OTHER CAUSES.

THOSE CAUSES INCLUDE CRANIAL TRAUMA, PENETRATING TRAUMA, POST-OP TIFF INFECTIONS, PATIENTS WITH BAD MASTOID OR EAR INFECTION OR SIGN U SINUSITIS WERE ALWAYS THE CASE BUT THE VAST MARKET OF INCREASE IS DUE TO THE PREVALENCE OF I.V.

DRUG USE.

>> WHAT KIND OF NUMBERS ARE WE TALKING ABOUT?

WHEN YOU SAY THERE IS AN INCREASE?

>> IN LOUISVILLE, IN 2012, THE NORTON HEALTHCARE SYSTEM TREATED ABOUT 12, WHAT WE CALL SPINAL ESPECIALLY DORAL ABSCESSES IN 2018, IT WAS 100.

>> THESE ARE THE I.V.

DRUG USERS.

>> YES, SIR.

>> IS THAT BECAUSE THEY'RE INJECTING IN THE ARM OR THE LEG OR BECAUSE THEY'RE INJECTING INTO THE SPINAL CHORD IN.

>> IT IS TYPICALLY FROM PERIPHERAL INJECTION, ARM OR LEG AND WHAT HAPPENS IS THE PATIENT GETS BACTERIA AND THEY HAVE WHAT IS A VEEN VEINOUS PLEXUS.

>> WHEN YOU TALK ABOUT THAT, YOU ARE TALKING ABOUT BACTERIA IN THE BLOODSTREAM.

>> YES, SIR.

>> AND THEN THEY WILL CEDE INTO THE VEINS ALONG THE SPINAL CHORD.

>> AND BRAIN AS WELL.

>> ARE THESE PEOPLE WHO HAVE HAD SOME OTHER KIND OF IMMUNE SYSTEM DISORDERS, WEAKENED OR HAPPEN TO ANYBODY.

>> IT CAN HAPPEN TO ANYONE.

IN THE PAST, PEOPLE WITH SPINAL EPIDURAL ABSCESSES, 20 YEARS AGO, THEY WERE REALLY POORLY CONTROLLED DIABETICS.

BUT THAT HAS WAY BEEN OVERTAKEN BY I.V.

DRUG USERS.

THEY, FOR THE MOST PART, DON'T HAVE IMMUNE KNOW IMMUNOCOMPROMISE.

>> IS IT ONE TIME OR MULTIPLE.

>> REUSE OF NEEDLES, NOT ANTISEPTIC.

>> DO YOU TYPICALLY FIND THEY HAVE OTHER INFECTIONS AT THE SAME TIME.

>> INFECTIONS AS WHAT... >> ARE THEY TYPICALLY GOING TO GET H.I.V.

OR HEPATITIS OR THINGS LIKE THAT?

>> THERE IS A LARGE CORRELATION BETWEEN THE USE OF THE NEEDLES AND HEPATITIS AND H.I.V.

SO A LOT OF TIMES THEY ARE HEPATITIS A AND C POSITIVE.

>> YOU SAID YOU CAN SEE THESE AROUND THE BRAIN AREAS AND THE SPINE, TOO?

>> YES, SIR: SO THE PEOPLE WHO TYPICALLY GET CNS INFECTIONS IN THE BRAIN ARE TYPICALLY PEOPLE WITH BAD OTITIS INFECTIONS EAR INFECTIONS OR SINUS AND THAT IS DIRECT TRANSMISSION.

THE VAST MAJORITY OF PEOPLE WITH EPIDURAL ABSCESSES ARE FROM I.V.

DRUG USE.

>> I WANT TO TALK ABOUT THE EAR AND SINUS BECAUSE MY GRANDMOTHER USED TO TELL ME, NEVER SNORT LIKE THAT BECAUSE IF YOU DO THE THAT, YOU ARE GOING TO GET AN INFECTION IN THE BRAIN.

SHE WAS RIGHT?

>> IN A WAY, YES, SHE WAS RIGHT.

GRANDMOTHERS ARE ALWAYS RIGHT.

SO ANY TIME A PERSON HAS OTIS MEDIA WHICH IS COMMON, THAT IS ALWAYS A POSSIBILITY.

NOW IT'S RARE, BUT IT DOES HAPPEN.

SINUSITIS, BAD SINUS INFECTION CAN CAUSE DIRECT TRANSLOCATION OF BACTERIA.

WHEN WE WERE AT THE UNIVERSITY OF LOUISVILLE, PENETRATING TRAUMA WAS ONE OF THE BIGGEST CAUSES OF IT.

>> DIRECTLY INTO THE HEAD?

>> YES, SIR.

OPEN SKULL FRACTURE, PENETRATING TRAUMA FROM GUNSHOT WOUND, STAB WOUND TO THE SKULL, THINGS OF THAT SORT.

>> TELL ME ABOUT POOR, MULTIPLE CAVITIES.

>> A PERSON CAN DEVELOP ORAL ABSCESSES AND THOSE ABSCESSES CAN SPREAD INTO THE BLOOD AND DIRECT TRANSLOCATION OR SPREAD THROUGH THE BLOOD.

>> HOW DOES ONE KNOW WHEN YOU HAVE AN INFECTION IN THE BRAIN AREA?

>> A LOT OF TIMES IT IS NOT KNOWN UNTIL A PERSON IS IMAGED.

ONE OF THE MAIN CAUSES, HEADACHES, SEIZURES, PERSON THAT PRESENTS TO A LOCAL EMERGENCY ROOM WITH A SEIZURE TYPICALLY WILL GET A C.T.

SCAN OF THEIR HEAD AND SOMETHING WILL BE NOTICED THERE.

THE BEST WAY TO ACTUALLY SEE A CNS INFECTION IS MRI WITH CONTRAST.

>> REALLY?

>> YES, SIR.

>> DO THESE PEOPLE HAVE CHILLS AND FEVER, TOO?

>> A LOT OF TIMES THEY WILL, YES.

A LOT OF TIMES THEY WILL BE SYSTEMICALLY WILL, BUT SOMETIMES THEY WON'T.

THEY'RE PRESENTING SYMPTOM, ESPECIALLY IN THE BRAIN, IS A SEIZE WHY YOU ARE.

>> SO IT'S NOT SO MUCH THAT THEY'LL COME IN BUT THEIR FAMILY MEMBER MAY BRING THEM IN BECAUSE OF SOME CHANGE?

>> FAMILY MEMBER WILL BRING THEM IN OR A PERSON COMES IN IN THE SEPTIC STATE AND AND DURING THE WORKUP IN THE EMERGENCY ROOM, IMAGE IS IS DONE THAT FINDS IT OR PATIENTS WITH A SPINAL EPIDURAL ABSCESS SOMETIMES THAT FLUID COLLECTION CAN PRESS ON THE SPINAL CHORD AND CAN CAUSE GRAWD PLEEJIA OR-- QUAD PLEEJ QUADRIPLEGIA.

>> IF ITINGS GOING ON IN THE HEAD, DO THEY GET HEADACHES?

>> TYPICALLY, YES.

>> BAD HEADACHE, MAYBE CHILLS AND FEVER.

>> IT COULD, BUT HEADACHES OR SO-- HEADACHES SUCH A WIDE RANGE OF THINGS THAT CAN CAUSE HEADACHES BUT IF A PERSON HAS BAD OTITIS MEDIA, HEADACHE, POOR DENTITION, IT SHOULD BE ON THE RADAR THAT THIS IS A PERSON WHO HAS THE POTENTIAL FOR CNS INFECTION.

>> NOW I WANT TO GO BACK TO THE DRUG ADDICTION PROBLEM WITH PEOPLE SHOOTING UP.

YOU SAID IT'S NOT NECESSARILY BECAUSE I WAS THINKING THAT WHEN SOMEONE WOULD GET SOMETHING IN THE SPINAL CHORD AREA BECAUSE THEY'RE SHOOTING UP IN THE NECK OR BACK.

>> TIP TYPICALLY IT'S NOT.

>> IT CAN BE ANYWHERE.

LET'S LOOK AT THE FIRST X-RAY YOU BROUGHT ALONG TO US.

NOW DESCRIBE WHAT IT IS THAT WE ARE SEEING.

WHAT IS THE WHITE STUFF, THE DARK STUFF?

>> WHAT WE ARE LOOKING AT IS A CONTRASTED MRI OF THE CERVICAL SPINE AND WHAT IS IMPORTANT, THERE IS AN AREA THAT YOU CAN SEE THERE THAT IS A SPINAL EPIDURAL ABSCESS.

THIS IS ACTUALLY A PATIENT FROM LAST WEEK.

HE PRESENTED WITH NECK PAIN AND ARM WEAKNESS.

AND SUBSEQUENT MRI REVEALED SOMETHING THERE AND THEN A FOLLOW ON MRI WITH CONTRAST REVEALED A SPINAL EPIDURAL ABSCESS.

>> SO IT'S CONCEIVABLE THAT SOMEONE COULD BE SITTING AT HOME, HAVE SOME WEAKNESS IN THEIR LEFT ARM AND JUST THINK THEY'RE HAVING A STROKE OR SOMETHING LIKE THAT?

>> IT IS, BUT THOSE THINGS OF ARE MORE MORE COMMON THAN SPINAL EPIDURAL ABSCESS.

THE MAIN THING IS THE HISTORY.

WHEN YOU REALLY TALK TO A PERSON AND THEY'RE VERY HONEST.

I HAVE BEEN USING I.V.

DRUGS OR TOXICOLOGY SCREEN WILL PROMPT THE QUESTION AND THEN THEY'LL ANSWER.

>> DO THEY HAVE PAIN AT THE SITE WHERE THE ABSCESS IS LOCATED?

>> THEY TYPICALLY DO HAVE PAIN, YES.

>> AND IS IT JUST WHEN YOU TOUCH IT OR THEY MOVE THEIR NECK?

>> WITH MOVEMENT.

IT'S NOT SOMETHING YOU CAN PAL PAY THE BUT WITH MOVEMENT.

>> I GUESS I'M THINKING ABOUT MENINGITIS.

>> THESE PEOPLE DON'T HAVE MENINGITIS.

THEY TYPICALLY HAVE LOCALIZED PAIN.

BECAUSE MENINGITIS IS A BIT DIFFERENT IN THE SENSE THAT IT IS AN INFLAMMATION OF THE MENINGIES WHERE THERE IS A LOCALIZED INFECTION.

THESE PEOPLE TYPICALLY DON'T HAVE THE SIGNS AND SYMPTOMS OF MENINGITIS.

>> DOES IT SPREAD FROM THERE UP OR DOWN OR JUST STAY RIGHT IN THAT LOCALIZED AREA?

>> A LOT OF TIMES IT'S MULTIFOCAL.

YOU CAN HAVE A PERSON THAT CAN HAVE A FLUID COLLECTION IN THE CERVICAL SPINE, THE NECK, THORACIC SPINE, MID BACK OR LUMBAR, LOW BACK.

>> THE SECOND SLIDE THAT YOU BROUGHT ALONG WITH YOU, LOOKS SIMILAR, BUT THERE IS A DIFFERENCE.

>> IT IS SIMILAR.

IT'S THE EXACT SAME THING.

A PATIENT WITH I.V.

DRUG USE UNFORTUNATELY, PRESENTED WITH NECK PAIN.

MRI WAS A BIT UNEQUIVOCAL, COULDN'T FIGURE OUT WHAT IT WAS.

DO THE MRI WITH CONTRAST AND YOU CAN SEE THAT FLUID COLLECTION.

>> I WANT TO KEEP ON A ROLL HERE BECAUSE THIS THIRD ONE HERE, THIS IS SOMETHING THAT I SAW, COULD I PICK THIS ONE OUT.

>> THIS PATIENT, SAME HISTORY, BUT WHAT IS DIFFERENT HERE IS THEY HAVE BAD OSTEOMY LIGHTS, INFECTION OF THE BONE, INFECTION OF THE DISK IN BETWEEN THE BONE AND A SPINAL EPIDURAL ABSCESS.

>> SO IS THIS PERSON MORE COMPLICATED THAN THE FIRST TWO THAT WE SAW.

>> THEY'RE MORE COMPLICATED TO TREAT BECAUSE NOT ONLY DO YOU NEED TO REMOVE THE INFECTED FLUID BUT THEY NEED STRUCTURAL SUPPORT IN THEIR SPINE BECAUSE THAT BONE THAT IS INFECTED HAS BEEN WEAKENED DOES THIS MEAN THE PERSON HAS TO GO TO SURGERY?

>> NO, SOMETIMES THIS CAN BE TREATED WITH ANTIBIOTICS, BUT WE ARE ALWAYS CAUTIOUS BECAUSE THE ANTI-BUYOUTIC-- ANTICIPATE BIOTICS-- THE ANTIBIOTICS, DOES A PERSON IMPROVE IN THERE I MRI IMAGING AND CLINICALLY?

DO THEY FEEL BETTER?

SOMETIMES IT'S TO A POINT WHERE IT IS A SIGNIFICANT RISK TO NOT OPERATE ON THEM, TO WAIT AND WATCH.

AND SO AS NEUROSURGEONS, WE ARE AGGRESSIVE IN THE SENSE THAT WE SHOULD ADDRESS THIS SURGICALLY IF WE CAN.

>> BUT I'M WONDERING, IF SOMEONE COMES IN COMPLAINING OF SOME ARM WEAKNESS, IS THERE A CHANCE THAT THAT COULD BE PERMANENT IF YOU DON'T GET IN THERE RIGHT AWAY?

>> WELL, IF WE ASSUME THAT IT IS A SPINAL EPIDURAL ABSCESS, THAT PERSON WOULD BE IMMEDIATELY TAKEN TO SURGERY BECAUSE THEY HAVE A NEUROLOGIC DEFICIT.

THE PATIENT YOU WOULD WATCH AND TREAT WITH ANTIBIOTICS, THOSE ARE THE PEOPLE WHO ONLY HAVE PAIN BUT NO NEUROLOGICAL DEFICIT SO THERE IS A DIFFERENCE.

>> WHAT IS YOUR APPROACH WHEN YOU DO DECIDE SCRU TO OPERATE-- WHEN YOU DECIDE TO OPERATE ON SOMEONE.

DO YOU MAKE A SMALL INCISION.

>> IT DEPENDS WHERE THIS ANTERIOR TO THE SPINAL CHORD.

IF IT IS ANTERIOR WE CAN APPROACH IT FROM THE NECK HERE.

IF IT IS POSTERIOR WE CAN APPROACH IT THIS WAY.

IF IT IS IN THE THROR RASSIC SPINE, IT CAN BE APPROACHED FROM BEHIND AND IN THE LUMBAR SPINE IT CAN BE APPROACHED FROM THE FRONT OR BEHIND, DEPENDING ON THE LOCATION OF THE FLUID COLLECTION BECAUSE YOU TYPICALLY HAVE TO REMOVE SOME BONE TO GO GET TO IT AND THAT CAN LEAVE THE PATIENT UNSTABLE AND THEY NEED SOME TYPE OF CERVICAL OR LUMBAR THORACIC IMPLEMENTATION TO STABILIZE THEIR SPINE.

>> MANY OF US ARE AWARE OF PEOPLE WHO HAVE ABSCESSES ON THEIR ARM OR SOMEPLACE AND THEY COME SEE A PERSON LIKE ME, SOME HACK LIKE ME AND WE JUST OPEN IT UP RIGHT THERE AND DRAIN THE ABSCESS AND LET THE PUSS OUT.

BUT THAT'S NOT WHAT YOU ARE DOING, OR IS THAT WHAT YOU ARE DOING?

>> WE ARE, YES, WE ARE REMOVING-- >> SIMPLE DRAINING THE PUSS LIKE THAT?

>> IT'S AN ENCLOSED PACE WHICH IS THE DIFFERENCE.

MOST SOFT TISSUE, THIS IS USUALLY IN THE SPINAL COLUMN SO HAVE YOU TO ACTUALLY OPEN THE SPINAL COLUMN AND THAT IS OPEN THE BONE IN ORDER TO GET TO THE ABSCESS AND THEN THAT SOMETIMES MEANS YOU NEED TO STABILIZE IT AFTERWARDS SO A BIT MORE COMPLEX THAN, YES.

>> QUITE A BIT MORE COMPLEX I WOULD SAY.

>> SO DO YOU LEAVE A DRAIN THIS THERE TO FACILITATE MATERIAL COMING OUT.

>> TYPICALLY A DRAIN IS LEFT AND THAT PATIENT IS PLACED ON SIX TO EIGHT WEEKS OF I.V.

ANTIBIOTICS.

>> ARE THEY IN THE HOSPITAL THE WHOLE TIME?

>> TIP TYPICALLY NOT IN THE HOSPITAL THE WHOLE TIME BUT THAT'S PART OF THE COMPLICATION OF IT BECAUSE NOW YOU HAVE A PATIENT WHO IS PRONE TO I.V.

DRUG USE WHO HAS A VERY NICE I.V.

ACCESS NOW AND SO THOSE ARE THE SOCIAL ISSUES THAT WE HAVE OUR COLLEAGUES IN HARM REDUCTION COME AND TALK TO THE PATIENT ABOUT, YOU KNOW, YOU REALLY HAVE TO USE THIS FOR THE ANTIBIOTICS BECAUSE THIS COULD REALLY CAUSE A PROBLEM.

>> HOW OFTEN DOES THAT PRESENT ITSELF AS THAN ISSUE FOR YOU?

>> A PATIENT-- >> WHO MIGHT USE THEIR VASCULAR ACCESS AS A PORT.

I CAN IMAGINE THEY'RE NOT GOING TO USE STERILE TECHNIQUE AND YOU GOT THIS THING INFECTED.

>> IT IS HARD TO SAY.

I THINK THAT, IN MY EXPERIENCE, THE PATIENTS THAT I HAVE SEEN HAVE BEEN SO SHOCKED AND SO TRAUMATIZED BY THE NEED FOR THESE BIG SURGERIES THAT A LOT OF TIMES IT GETS THEM NOT NECESSARILY IN THE RIGHT DIRECTION, BUT IT REALLY MAKES THEM CONSIDER, YOU KNOW, THIS IS MY SECOND CHANCE.

>> SO WHEN YOU TALK ABOUT WHEN YOU ARE GOING IN FOR SOMEONE WHO HAD, LIKE THE ABSCESSES WE SAW ON THE FIRST TWO PAGES, YOU TALK ABOUT BUILDING THAT UP, ARE YOU PUTTING BONE BACK IN THERE OR SOMETHING ELSE?

>> SO IF WE HAVE TO GO AN TER AN TEARIALLY, WE PUT A TITANIUM CAGE IN THERE TO GIVE STRUCTURAL SUPPORT.

BUT A LOT OF TIMES THEY NEED STRUCTURAL SUPPORT AND HAVE YOU TO TAKE OUT THE BONES AND REPLACE THAT WITH STRUCTURAL CAGES.

TITANIUM AGES.

>> IT SEEMS LIKE I REMEMBER THAT WHEN PUTTING A FOREIGN BODY IN THE PLACE WHERE THERE IS AN INFECTION, YOU RUN THE RISK OF THAT MATERIAL BECOMING INFECTED, TOO.

>> CORRECT.

AND THAT IS A RISK.

BUT WE DEEM IT AN ACCESSIBLE RISK BECAUSE THERE IS NO OTHER STRUCTURAL WAY TO DO IT.

WE USE MEDICAL GRADE TITANIUM WHICH IS BACTERIAL STATIC MEANING IT IS NOT GOING TO PROMOTE AN INFECTION AND THAT PATIENT IS ON SIX TO EIGHT WEEKS OF ANTIBIOTICS.

I.V.

ANTIBIOTICS AND SOMETIMES ORAL ANTIBIOTICS AFTER THAT.

>> LONG-TERM AFTER THAT.

>> LONGER TERM.

NOT, YOU KNOW, THREE MONTHS.

>> BACK WHEN I WAS A RESIDENT BACK IN WASHINGTON D.C., LONG, LONG, LONG TIME AGO, I REMEMBER WE HAD A PATIENT WHO HAD SEVERE OSTEOMILITIS FROM THEIR I.V.

DRUG USE THAT THEIR NECK WAS NOT STABLE AND THEY HAD TO WEAR ONE OF THESE HALO DEVICES.

DO YOU STILL HAVE TO GET TO THAT SORT OF THING?

WHERE YOU STRUCTURALLY HAVE TO SUPPORT THE NECK?

>> WE HAVEN'T RECENTLY.

OUR GOAL HAS CHANGED SUCH THAT WE WOULD LIKE TO HAVE INTERNAL STABILIZATION.

HALO IS EXTERNAL STABILIZATION AND WE TRY TO DO IT WITH INTERNAL STABILIZATION BECAUSE IT HELPS A PERSON REHAB BETTER WITHOUT THE HALO.

WE TYPICALLY DON'T USE IT UNLESS WE NEED TO.

>> SHIFT GEARS A LITTLE BIT.

WHAT IS YOUR APPROACH WHEN YOU HAVE AN INFECTION WITHIN THE SKULL ITSELF.

>> SO THAT IS A DIFFERENT CHALLENGE BECAUSE IT INVOLVES THE BRAIN.

THE EASIER THING ABOUT IT IS IT DOESN'T TYPICALLY NEED STRUCTURAL SUPPORT AS OUR SPINAL COLUMN DOES.

BUT WE TYPICALLY HAVE TO DO CRANIOTOMIES AND DRAIN THOSE FLUID COLLECTIONS.

SOMETIMES THEY CAN BE TREATED WITH ANTIBIOTICS BUT AS THE SIZE OF THAT INFECTION POCKET INCREASES, THE ANTIBIOTIC PENETRATION VIA ANTIBIOTICS DECREASES AND YOU HAVE TO ACTUALLY DRAIN IT.

AND SO AT THE NORTON INSTITUTE, WE HAVE BEEN USING NUCLEAR NAVIGATION NEURAL NAVIGATION TO DRAIN IT THAT WAY RATHER THAN A FULL AND FORMAL CRANIOTOMY.

>> I CAN'T LET YOU GO AWAY WITHOUT AT THE TIMING YOU TELL ME ABOUT NEURAL NAVIGATION.

WHAT DOES THAT MEAN?

>> NEURAL NAVIGATION IS A RELATIVELY MODERN WAY THAT WE ACCESS, IN THREE DIMENSIONS, CERTAIN SPACES IN THE INTRAIN.

BRAIN.

AND WHAT IT DOES, DIFFERENT SYSTEMS BUT BASICALLY IT TAKES A SET OF IMAGES, C.T.

SCAN OR MRI AND PUTS IT INTO A COMPUTER SYSTEM AND THEN THERE IS A CAMERA THAT LOOKS AT AT THE PATIENT AND THERE ARE CERTAIN MARKERS AROUND OR ON THE PATIENT AND IT ALLOWS US TO SEE THAT SPACE THAT WE ARE TRYING TO ACCESS.

IN LAYMAN'S TERMS, IT WOULD BE LIKE GPS FOR SURGERY.

>> THAT'S PRETTY GOOD.

IS THIS DONE IN AN OPERATING ROOM OR RADIOLOGY?

>> OPERATING ROOM.

>> SO INSTEAD OF HAVING TO MAKE A LARGE HOLE, I GUESS, YOU CAN MAKE JUST A HOLE BIG ENOUGH FOR THIS NEEDLE TO GO THROUGH?

>> CORRECT.

>> NEURAL NAVIGATION IN TERMS OF BRAIN TUMORS AS WELL, IT ALLOWS FOR SMALLER INCISIONS, SMALLER HOLES IN THE SKULL AND MORE ACCURATE PLACEMENT OF DEVICES OR FINDING TUMORS AND IN OUR CASE, CRANIAL ABSCESS.

>> SO ONCE YOU HAVE DRAINED A CRANIAL ABSCESS, AGAIN, HAVE I TO ASK, DO YOU LEAVE A DRAIN IN THERE FOR OR DO YOU SUCK THE MATERIAL OUT OR SCOOP IT OUT?

WHAT YOU ARE TRYING TO DO IS REDUCE THE VOLUME.

SOMETIMES, UNFORTUNATELY, THERE IS A TOUGH FIBROUS RIND AROUND THE FLUID AND THAT NEEDS TO BE RESECTED BECAUSE IT WILL CONTINUE TO CEDE THE CNS.

>> SO HAVE YOU TO GO IN THEN.

>> YES, THAT WOULD BE MORE THAN JUST A NEEDLE.

THAT WOULD BE THE FULL CRANIOTOMY.

>> WHAT OTHER LONG-TERM COMPLICATIONS FOR PATIENTS WHO HAVE HAD CRANIAL ABSCESS?

>> SEIZURES NUMBER ONE.

THEY'RE ALWAYS PRONE TO ANOTHER ONE BECAUSE THERE IS ALWAYS A QUESTION, IS IT FULLY TREATED.

AND THEY CAN HAVE COGNITIVE DIFFICULTIES.

AND THINGS OF THAT SORT.

JUST DEPENDING ON THE LOCATION.

>> SO ANY COMPLICATIONS FROM THE SURGERY ITSELF IF THEY HAVE TO GO THAT ROUTE?

OR JUST THE TYPICAL THINGS.

>> TYPICAL THINGS YOU WOULD EXPECT FROM A CRANIOTOMY.

BUT MOST OF THE LONG-TERM EFFECTS ARE FROM THE ABSCESS ITSELF.

>> WHAT ABOUT FOR PATIENTS WHO HAVE THEM IN THE SPINAL CHORD?

ANY LONG-TERM COMPLICATIONS TO WATCH OUT FOR?

>> I THINK IN MY EXPERIENCE, THE LONG-TERM COMPLICATION IS CHRONIC PAIN.

>> REALLY?

>> YES.

>> BECAUSE THEY'VE HAD THIS INFECTION.

THEY HAVE AN INFLAMMATORY RESPONSE IN THAT AREA AND TYPICALLY THEIR MAJOR COMPLAINT IS PAIN.

NOW THERE ARE SOME PATIENTS THAT HAVE A NEUROLOGICAL DEFICIT WHEN THEY PRESENT AND EVEN THOUGH YOU TAKE THE PRESSURE OFF THE SPIEM CHORD, THE TIME THAT HAS PASSED HAS BEEN SUCH THAT THEY DON'T REGAIN THAT FUNCTION AND SO MAJOR COMPLICATIONS MAJOR LONG-TERM, THEY CAN HAVE NEUROLOGICAL DEFICITS.

>> THESE PATIENTS DIDN'T HAVE TO GO IN FOR REHAB?

>> YES, SIR.

>> WHEN YOU SEE PATIENTS AND YOU KIND OF TOUCHED ON THIS WHEN YOU SETTED YOU HAD TO PUT A VASCULAR ACCESS BUT WHEN PATIENTS COME IN WHO HAVE THESE COMPLICATIONS FROM I.V.

DRUG ABUSE, YOU MENTIONED ABOUT THE HARM TEAM THAT YOU HAVE.

ARE THESE PATIENTS PUT INTO OR ARE THEY JUST ENCOURAGED TO GET INTO ADDICTION REHAB KIND OF FACILITY OR PROGRAM?

>> I THINK THE HARM REDUCTION TEAM PRESENTS THOSE THINGS.

OF COURSE WE CAN'T FORCE ANYBODY TO GO INTO REHAB AND THINGS OF THAT SORT BUT A LOT OF TIMES IT'S AN EYE OPENER TO SAY, YOU KNOW, SOME PEOPLE DON'T REALIZE THE HARM THAT THEY HAVE PUT THEMSELVES IN AND SOMETIMES IF THEY'RE JUST EDUCATED AS TO THE CAUSE OF ALL OF THIS PAIN AND THE NEED FOR MULTIPLE SURGERIES AND REHAB IS BECAUSE OF A BEHAVIOR, SOMETIMES THAT CAN MODIFY IT.

>> ENOUGH TO THEY SAY, SCARE SCRAIT ALMOST?

>> YES, SIR.

>> WHAT SCARES YOU THE MOST WHEN YOU ARE OR DEALING WITH SOMEONE WHO IS AN I.V.

DRUG ADDICT AND COMES IN WITH AN ABSCESS?

DOES ANYTHING REALLY MAKE YOU SAY OH MY GOD?

>> THE THING THAT WORRIES ME IS A PATIENT THAT IS TREATED NON-OPERATIVELY, I'M WORRIED THEY'RE GOING TO HAVE SOME TYPE OF DEFICIT OR SOME TYPE OF PROBLEM AND BECAUSE OF THEIR CONTACT WITH THE HEALTHCARE SYSTEM, THEY'RE AFRAID TO RECONNECT WITH THE HEALTHCARE SYSTEM AND SAY HEY, YOU KNOW, I HAD THIS PROBLEM AND I'M GETTING WORSE, YOU KNOW, AND A LOT OF TIMES I THINK THAT'S WHAT PUSHES US TO INTERVENE AT THAT TIME SURGICALLY BECAUSE THE PATIENT POPULATION THAT WE DEAL WITH, WE OFTEN HAVE TROUBLE WITH FOLLOW-UP.

THEY ONLY SHOW UP FOR FOLLOWUP APPOINTMENTS IF WE SAY, WE NEED TO YOU GET THIS MRI NEXT WEEK.

AND YOU NEVER SEE THEM AGAIN.

>> IS THERE, WHEN YOU ARE LOOKING AT FOLKS LIKE THIS, DO THEY TRUST YOU?

I JUST WONDER.

TOUCHING ON WHAT YOU WERE JUST SAYING, THERE HAS TO BE A SENSE THAT YOU ARE GOING TO TRY TO DO SOMETHING THAT HELPS ME BUT IT IS A REALLY BIG PROBLEM.

>> IT IS VARIABLE.

I'VE HAD PATIENTS WHO REALLY SAY, YOU KNOW, IF YOU CAN HELP ME GET THROUGH THIS, I'M GOING TO TAKE A NEW TURN IN LIFE.

AND I HAVE OTHER PATIENTS WHO, BECAUSE OF OTHER REASONS, THEY HAVE A DISTRUST OF HEALTHCARE SYSTEM IN GENERAL, DOCTORS SPECIFICALLY.

AND WHAT I TRY TO DO IS, I PRESENT MYSELF IN A SENSE THAT, I DON'T CARE HOW YOU GOT THIS.

I JUST WANT TO HELP YOU FLEW THIS.

THROUGH THIS.

WE CAN TALK ABOUT THOSE THINGS LATER.

>> SO THESE PATIENTS WHO COME IN WHO HAVE THE CNS INFECTION SOBERED WITH I.V.

DRUG USE, DO YOU AUTOMATICALLY LOOK FOR THE BACTERIAL ENDOCARDITIS OR VALVE ISSUES?

>> A LOT OF TIMES WE DO.

WE HAVE OUR COLLEAGUES IN CARDIOLOGY DO A T.E.E.

AND A LOT OF TIMES THEY HAVE CARDIAC VEGETATIONS.

THERE ARE MANY PATIENTS THAT HAVE HAD MULTIPLE SPINE SURGERIES AND THEN THEY HAVE VALVE REPLACEMENT FOR ENDOCARDITIS.

>> SO IT'S NOT UNCOMMON IF THEY HAVE AN INFECTION, YOU CAN HAVE MULTIPLE INFECTIONS IN THE SPINAL CHORD BUT THEY COULD HAVE OTHER ISSUES AROUND, TOO?

>> I'VE HAD PATIENTS THAT WERE NOT INITIALLY MY PATIENTS BUT THEY WERE ADMITTED TO THE ICU FOR CONGESTIVE HEART FAILURE.

VEGETATIONS ON THE VALVE.

THEY MENTION BACK PAIN, YOU GET AN MRI AND THERE IS A SPINAL EPIDURAL ABSCESS.

>> FINALLY IN A MINUTE, PEOPLE WHO HAVE CHRONIC EAR PAIN OR SINUS TROUBLE, WHAT SHOULD THEY WATCH OUT FOR?

>> I THINK THOSE THINGS HAVE TO BE TREATED PERSISTENT HEADACHE, SEIZURES.

OUR INDEX FOR SUSPICIOUS SUSPICION IS LOW.

SO IT TAKES 30 SECONDS TO GET A CAT SCAN.

ANY HEADACHE THAT IS OUT OF THE ORDINARY AND PERSIST TENT, ESPECIALLY IN CONNECTION WITH EAR INFECTIONS OR SINUSITIS, TALK TO YOUR DOCTOR AND GET IT CHECKED OUT.

>> I HAVE TO TELL YOU, MAN, I'M FASCINATED TO HEAR ABOUT CNS INFECTIONS.

I DO APPRECIATE YOU BRINGING THIS TO THE FOREFRONT AND I WANT TO THANK YOU FOR YOUR 25 YEARS TO YOUR COMMUNITY.

>> THANK YOU.

I WOULD LIKE TO THANK YOU FOR BEING WITH US TODAY.

I HOPE THAT YOU HAVE A BETTER UNDERSTANDING OF SOME OF THE SIGNS AND SYMPTOMS ASSOCIATED WITH CENTRAL NERVOUS SYSTEM INFECTIONS AND NOW YOU KNOW SOME OF THE THINGS YOU CAN DO TO AVOID THESE TYPES OF INFECTIONS.

IF YOU WISH TO WATCH THIS SHOW AGAIN OR WATCH AN ARCHIVED VERSION OF PAST SHOWS, PLEASE GO TO ket.org/HEALTH.

IF YOU HAVE A QUESTION OR COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KYHEALTH@ket.org.

PLEASE BE SAFE AND CONSIDERATE OF OUR NEIGHBORS AND I'LL LOOK FORWARD TO SEEING YOU ON THE NEXT KENTUCKY HEALTH.

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