Spinal Epidural Abscess: Raising the Index of Suspicion

Area of Science:

• Neurology
• Infectious Diseases
• Radiology

Background:

• Spinal epidural abscesses are rare but life-threatening infections, often requiring surgical intervention and antibiotics.
• Contrast-enhanced MRI is the standard diagnostic tool for spinal epidural abscesses due to its high accuracy.

Observation:

• An 81-year-old female presented with acute bilateral lower extremity weakness and low back pain.
• Initial non-contrast MRI of the lumbar spine showed degenerative changes but did not explain the neurological deficits.
• Elevated white blood cell count and clinical presentation raised suspicion for bacteremia and later, a spinal epidural abscess.

Findings:

• A contrast-enhanced MRI revealed a 17.1 mm spinal epidural abscess.
• The patient underwent emergent surgical debridement and received a six-week course of intravenous antibiotics.
• Diagnosis was delayed due to initial equivocal imaging findings.

Implications:

• This case highlights the critical role of clinical reasoning and thorough neurological examination in diagnosing spinal epidural abscesses.
• Vigilance against diagnostic biases and maintaining a broad differential diagnosis are essential for timely and accurate patient assessment.
• Early and accurate diagnosis of spinal epidural abscesses can significantly improve patient outcomes and minimize long-term complications.