Upper cervical epidural abscess with emphasis on diabetes as a risk factor: a case report
Nagi A Massoud1, Abdulrahman H Alashkar2, Mohammad A Aljawash2
1Department of Surgery, Doctor Sulaiman Al-Habib Medical Group, Buraidah, Qassim, Saudi Arabia. Nagi.massoud73@hotmail.de.
BMC Neurology
|September 28, 2024
Summary
A rare upper cervical spine epidural abscess (UCEA) case highlights the importance of screening for diabetes mellitus (DM). Surgical intervention led to full neurological recovery, even after prolonged deficits, emphasizing prompt treatment for spinal epidural abscesses.
Area of Science:
- Neurology
- Neurosurgery
- Infectious Disease
Background:
- Upper cervical spine epidural abscess (UCEA) is a rare condition affecting the occiput to C2 region.
- Atlantoaxial joint instability is a significant risk associated with UCEA.
- Diabetes mellitus (DM) is a frequently reported risk factor for spinal epidural abscesses (SEAs).
Observation:
- A 56-year-old male presented with headache, neck pain, and left-sided weakness.
- Initial workup revealed hyperglycemia and an elevated HbA1c (10%).
- MRI showed C2 spondylitis and a craniocervical junction abscess.
Findings:
- The patient underwent a two-stage surgical decompression and stabilization.
- Full motor recovery was achieved approximately three months postoperatively.
- Neurological deficits were present for over five days prior to surgery.
Implications:
- Screening for DM is recommended for SEA cases lacking clear risk factors.
- Surgical management is crucial for UCEA due to atlantoaxial instability risks.
- Complete neurological recovery is achievable even with delayed surgical intervention.
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