[Spinal epidural abscess as the cause of torticollis--diagnosis by magnetic resonance imaging].
Spinal epidural abscesses are rare, accounting for only 0.2-1.2 of every 10,000 hospital admissions. Because they often present with non-specific symptoms, they are frequently misdiagnosed. We present a case in which superconduction MRI was used to make the diagnosis and to follow the clinical course of a spinal epidural abscess. In December 1988, a 33-year-old male developed spiking fever and the sudden onset of torticollis. He had had a cerebral palsy from birth, with chronic tetraparesis and mental retardation. Isolation of staphylococcus aureus in urine and blood cultures confirmed the diagnosis of pyelonephritis and septicemia. A high fever persisted despite antibiotic therapy commenced immediately. A technetium 99 m scan showed a localized uptake of isotope in the cervical spine. An MRI examination performed in the following day under sedation showed a mass with the same signal intensity as muscle on T1-weighted images. It was located behind the vertebral bodies C1-Th1 compressing the spinal cord. In addition, a lesion with a decreased signal was also evident in the C5-C6 vertebral bodies. Because of torticollis, the patient was unable to keep his head still for a sufficient period of time, to obtain T2-weighted imaging. The MRI findings indicated the presence of a spinal epidural abscess and osteomyelitis. A second MRI done one month after admission showed a reduction in the size of the epidural mass, but further diminishing of the signal intensity of the vertebral lesion. One month later, the patient underwent the surgical removal of the pus and inflammatory soft tissue, and anterior fusion. The torticollis resolved following the operation.(ABSTRACT TRUNCATED AT 250 WORDS)
Fujimoto
N
N
Department of Neurology, Shiga Medical Center for Adult Diseases.
Nabatame
H
H
Nakamura
K
K
Konishi
T
T
Kamiya
Y
Y
D000038:Abscess / Q000150:complications* / Q000175:diagnosis; D000328:Adult; D004824:Epidural Space; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D013122:Spinal Diseases / Q000150:complications* / Q000175:diagnosis; D014103:Torticollis / Q000209:etiology*