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A rare presentation of spinal epidural abscess
Paul Robert Oliver Crowest1, Paul James Hughes, Andrew Elkins
1Department of Acute Medicine, NHS, Haywards Heath, UK. pcrowest@doctors.org.uk
BMJ Case Reports
|June 8, 2012
Summary
A patient with shortness of breath was diagnosed with spinal epidural empyema after intubation for an MRI. This rare condition, often reversible, was identified too late for effective intervention.
Area of Science:
- Neurology
- Neurosurgery
- Pulmonology
Background:
- A 77-year-old male presented with progressive shortness of breath.
- Initial investigations suggested bilateral diaphragmatic paralysis and possible motor neuron disease.
Observation:
- The patient required non-invasive ventilation and could not tolerate supine positioning for MRI.
- Intubation was necessary to obtain spinal imaging to rule out reversible causes.
Findings:
- MRI revealed multi-level spinal epidural empyema, a serious infection.
- The diagnosis was made despite significant challenges in imaging a ventilated patient.
Implications:
- Spinal epidural empyema can present insidiously with respiratory symptoms.
- Timely diagnosis and intervention are crucial for outcomes in spinal epidural empyema.
- This case highlights the importance of considering rare diagnoses in complex respiratory presentations.
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