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

Reference

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