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Acute progressive neurological decline in an elderly man.

Troy Burley¹, Michael Ross², Ryan Elliott³

¹Department of Physical Therapy, Rocky Mountain University of Health Professions, Provo, UT, USA.

Journal of Primary Health Care

|May 2, 2019

Summary

An elderly man with neck pain developed fever, confusion, and quadriplegia. A retropharyngeal abscess and methicillin-resistant Staphylococcus aureus pneumonia were identified as the causes.

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Area of Science:

Neurology
Infectious Disease
Physical Therapy

Background:

An 88-year-old male presented with severe, insidious neck pain, initially assessed as mechanical.
Physical therapy interventions including cervical taping and collar use provided no relief.

Observation:

The patient developed fever, mild confusion, diminished oxygen saturation, and elevated white blood cell count.
Chest imaging revealed pneumonia, and blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA).

Findings:

Cervical spine MRI showed severe central canal stenosis, cord signal abnormalities, and a retropharyngeal abscess.
The patient experienced progressive decline, developing quadriplegia below the C4 level.

Implications:

This case highlights the importance of considering serious underlying infections in elderly patients presenting with seemingly mechanical neck pain.
Prompt diagnosis and management of retropharyngeal abscesses and associated infections are critical to prevent severe neurological sequelae.