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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.