Quadriparesis from a panspinal extradural abscess following pneumococcal meningitis

A 63-year-old male presented with marked quadriparesis, three weeks after a pneumococcal meningitis. The MRI-scan was suggestive for extradural abscess in the craniocervical region extending into the lower thoracic spine. Cervical laminectomy was performed and a large abscess was drained. Culture revealed Streptococcus pneumoniae sensitive to benzylpenicillin. The patient was treated with antibiotics for six weeks. His neurological condition recovered completely, and he walked normally, without support, 6 weeks later. Pneumococcal infection of the extradural space is rare. The course of spinal epidural abscess is unpredictable and may present with quadriplegia. Complete recovery of the neurological deficit may occur if the abscess is drained before any ischaemic insult occurs to the cord.