What's the diagnosis? By Dr. Katie Selman

A 30 yo female presents with neck pain and bilateral arm weakness.  She states she has been having neck "soreness" for several weeks but for the last 3 days she has had difficulty raising her arms abover her head.  On arrival, her temperature is 101.2.  MRI was not immediately available so a CT is done and shown below.  What's the diagnosis?  Scroll down for answer.




Answer: cervical epidural abscess (with associated discitis, osteomyelitis, and spinal cord compression)

  • Abscess that develops in the epidural space between the dura and the vertebral body
  • S. aureus is most frequent cause
    • Pott's disease: spinal epidural abscess due to tuberculosis
  • Can occur from hematogenous spread or direct extension from nearby infection 
  • Most commonly affects thoracic and lumbar spine
  • Risk factors
    • IV drug use
    • immunocompromised state including diabetes and renal disease
    • recent spinal instrumentation - up to 22% of epidural abscesses are iatrogenic
    • recent spinal trauma
    • known distant site of infection
    • cancer
  • Classic triad - pain, fever, neuro deficit
    • most patients will not have all three
    • neurological deficit are due to direct compression or ischemia
  • Diagnosis
    • WBC is not sensitive or specific
    • ESR and CRP more  sensitive
    • MRI for definitive diagnosis
  • Pitfall - do not perform lumbar puncture in patient with suspected epidural abscess
  • Management
    • consult spine surgery
    • prolonged IV antibiotic course





Tanski ME, Ma O. Central Nervous System and Spinal Infections. In: Tintinalli JE, Ma O, Yealy DM, Meckler GD, Stapczynski J, Cline DM, Thomas SH. eds.Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9eNew York, NY: McGraw-Hill