Extensive Cervical Epidural Abscess: Case Report

Abstract

56 year old male from Rosetta complained of acute onset of neck pain for about 2 months with progressive course of upper limbs weakness with no sphincter affection. No previous dental nor neck nor back surgery nor acupuncture. History of renal impairment and on medical treatment for about 4 years. Body temperature was about 38.2 C. Physical examination showed marked mid neck tenderness, no palpable masses were felt, no lymph nodes were felt. Neurological examination revealed grade 3 paraparesis in the upper limbs while grade zero in both lower limbs on Medical Research Council (MRC) scale. Preservation of the deep sensation while loss of the superficial sensation, positive Hoffman sign and positive planter reflex. Magnetic Resonance imaging of the cervical spine showing ventral cervical spinal cord compression by an epidural abscess extending from the apex of dens to the level of C5. Decreased spinal canal diameter and mild spinal cord compression were present (Figure 1).