Epidural and paraspinal abscesses
Fever with neck pain for two weeks. Bilateral upper limb weakness last 24 hours.
Soft tissue neck
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In the upper cervical spine (C1 - C4), muscles of the left erector spinae group are swollen with surrounding inflammatory stranding, and small fluid collections with subtle peripheral enhancement are demonstrated in semispinalis capitis suggestive of abscess formation. The upper extent of longus cervicus and proximal levator scapulae muscles are also oedematous. No underlying cervical osteomyelitis/discitis is identified. Anterolaterally within the spinal canal from C2 to C3, the epidural space is eccentrically thickened on the left up to 4mm, and there is dural enhancement. No retropharyngeal abscess.
Probable epidural abscess located anterolaterally at the level of C2 to C3, associated with inflammation of left erector spinae muscle group with small semispinalis abscesses. Likely thrombosis of the left internal jugular vein with possible intracranial extension.
The patient proceeded to have C2 and C3 posterior decompression and drainage of epidural abscess.