Cervical epidural abscess as a cause of tetraparesis

Background: An epidural spinal abscess is a rare clinical condition which may cause rapid, irreversible neurological deterioration. Usually, the patient presents with back pain in the affected spinal segment, but the condition is rarely considered in the differential diagnosis.

Methods: A 57 year old man with no significant clinical history initially consulted complaining of cervicalgia. Some days later, this had worsened and he also had odinophagia, fever and general malaise. A diagnosis of retropharyngeal abscess was made. He was admitted to the Ear, Nose and Throat Department (ENT) and antibiotic treatment started with ceftazidime, vancomycin and clindamycin. Eight hours after admission he complained of paresthesia and subsequently of flaccid tetraparesia. CT and MR showed the presence of a paravertebral mass which extended to the epidural space between the fourth and seventh cervical vertebrae. On suspicion of a retropharyngeal abscess complicated by an epidural spinal abscess we proceeded to emergency operation and drained the prevertebral and epidural pus. On microbiological culture St. aureus was grown. The patient regained the mobility of his limbs. On discharge from hospital he still had paresia of the right leg, although this did not impede walking.

Conclusions: It should not be forgotten that, although rare, one of the causes of spinal compression and neurological deterioration (particularly in a febrile patient) is an epidural spinal abscess. Prompt diagnosis and satisfactory surgical decompression are essential to avoid irreversible neurological sequelae.