Presentation
Fever, headache and posterior neck pain. Medical history includes type II diabetes mellitus.
Patient Data
Bone marrow oedema is observed in the clivus, C1, and C2 vertebrae, along with surrounding ligaments and soft tissues. The affected areas exhibit low signal intensity on T1-weighted imaging and high signal intensity on T2-weighted imaging and STIR sequences.
A fluid collection within the spinal canal is located in the anterior epidural space, measuring approximately 6 x 31 mm (anteroposterior x craniocaudal dimensions). The fluid shows diffusion restriction (high signal on DWI and low signal on ADC) with peripheral enhancement after contrast administration. Compression of the cervical spinal cord and associated spinal cord oedema at the corresponding level are noted.
Degenerative changes in the cervical vertebrae and intervertebral discs are also noted.
Microbiology
cerebrospinal fluid (CSF):
bacteria cultured and identified: Staphylococcus aureus
peripheral blood:
bacteria cultured and identified: Staphylococcus aureus
Blood tests
Blood tests reveal elevated white blood cell count and neutrophil percentage, with decreased red blood cell count and haemoglobin levels.
Case Discussion
Imaging and test findings are consistent with an epidural abscess of the cervical spine caused by Staphylococcus aureus.
The patient was subsequently treated with a combination of two intravenous antibiotics, blood glucose levels were controlled with insulin, and close monitoring of clinical progress, blood tests, and consideration for surgical drainage of the abscess were conducted.
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