Migratory pain and acute neurological deficit, an enigma in the emergency in neurology: case report.

Abstract

Objective: Objective: Cervical epidural abscess has an estimated incidence of 0.2-2 cases per 10,000 hospital admissions, mortality is high, it usually presents clinically with pain, fever and neurological deficit, cervical pain being the most common symptom. The most isolated etiological agent is Staphylococcus aureus in 60-70%, commonly with multiple antibiotic sensitivity. Patients with this pathology present with elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) acute phase reactants, usually accompanied by leukocytosis. The diagnostic method of choice is nuclear magnetic resonance with gadolinium, with a sensitivity of 90%, prevailing over other similar studies. The early approach minimizes the rate of sequelae and mortality, with the start of treatment in the first 24-36 hours being especially important.

Conclusion: The diagnosis of this pathology represents a real diagnostic challenge, since it implies an exhaustive evaluation from the clinical and epidemiological point of view, including its low incidence, as well as paraclinical support. The clinical presentation is non-specific, warranting diagnostic suspicion from the initial moment. The duration of the symptoms and the early resolution (within the first 24-36 hours) minimize the possibility of important sequelae such as persistent neurological deficit.