Cervical Epidural Abscess: A Blind Spot for Postmortem Computed Tomography

Area of Science:

• Neurology
• Radiology
• Infectious Diseases

Background:

• Spinal epidural abscess (SEA) is an uncommon condition with potentially severe outcomes, including neurological deficits and death.
• Classical symptoms include spinal pain, fever, and neurological deficits, but diagnosis requires high clinical suspicion.
• Antemortem magnetic resonance imaging (MRI) is the gold standard for diagnosis, while computed tomography (CT) is less sensitive.

Observation:

• A case of Staphylococcus aureus cervical epidural abscess presented with neck pain, leading to flaccid paralysis and death.
• Antemortem MRI revealed a small epidural collection, spinal cord edema, and fluid in adjacent cervical disc and facet joints.
• These findings were not apparent on postmortem CT imaging.

Findings:

• Postmortem CT demonstrated limitations in diagnosing spinal epidural abscess, especially when subtle.
• The case highlights that spinal epidural abscesses can be missed on postmortem CT, potentially leading to underdiagnosis in forensic investigations.
• Antemortem MRI provided crucial diagnostic information that was not replicated by postmortem CT.

Implications:

• This case underscores the diagnostic limitations of postmortem CT for spinal epidural abscess.
• It suggests that some deaths attributed to other causes may be due to undiagnosed SEA.
• Emphasizes the importance of considering SEA in differential diagnoses, even with negative postmortem imaging findings.