Unexpected Spinal Epidural Abscess: A Real Emergency

Cervical and lower back pain are classic reasons for patients to seek care in the emergency department (ED). However, in rare instances, they signal serious underlying conditions, posing a significant diagnostic challenge. A 72-year-old male with history of lumbar spine surgery many years ago presented to the ED with neck pain for the last five days as well as bilateral lower limb weakness and feet paresthesia. His neurologic deficits rapidly progressed to crural tetraparesis, with a sensitive abnormal level by C4, associated with urinary retention and fever. An urgent cervical and dorsal magnetic resonance imaging (MRI) was performed, revealing an anterior fluid collection, causing secondary medullar compression, consistent with spinal epidural abscess (SEA). Cervical epidural abscess is an uncommon but potentially life-threatening condition that can lead to swift and irreversible neurological deterioration. With this clinical case, the authors highlight the relevance of clinical suspicion, interdisciplinary and coordinated work in the diagnosis of epidural abscess, as a time-dependent emergency.