A rare complication of cervical spinal epidural abscess while receiving conservative treatment

Abstract

Cervical spinal epidural abscess (CSEA) is a rare disease that requires prompt diagnosis and early surgical intervention with appropriate antibiotic therapy to ensure better neurologic outcome. However, some patients may forego surgery in some scenarios if they have prolonged neurologic deficits that are unlikely to improve with surgery. We present the first case of CSEA in which hydrocephalus developed while the patient was receiving medical treatment. A 55-year-old female with diabetes mellitus presented to our emergency department with progressive weakness and eventual paralysis. Spinal magnetic resonance imaging revealed CSEA with spinal cord compression. After 1 week of antibiotic treatment, hydrocephalus developed. The patient regained consciousness after emergent external ventricular drain. For sepsis source control, she received corpectomy with abscess drainage; however, there was no obvious neurological improvement. Emergency department crowding has become a widespread problem. Due to prolonged emergency department stay of patients, emergency physicians tend to face late response or complication of treatments, and witness the progression of diseases. This case demonstrates that hydrocephalus may occur in patients with CSEA receiving nonoperative treatment, and caregivers must be alert for any change in patient's consciousness.