Marques Beatriz R, Certal Mariana, Cerqueira Elisabete, Macedo Mariana, Exposito Beatriz
Internal Medicine, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Chaves, PRT.
Internal Medicine, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, PRT.
Cureus. 2024 Dec 3;16(12):e75013. doi: 10.7759/cureus.75013. eCollection 2024 Dec.
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.
颈部和下背部疼痛是患者前往急诊科就诊的常见原因。然而，在极少数情况下，它们预示着严重的潜在疾病，构成重大的诊断挑战。一名72岁男性，多年前有腰椎手术史，因颈部疼痛、双侧下肢无力和足部感觉异常，在过去五天内前往急诊科就诊。他的神经功能缺损迅速发展为下肢四肢瘫，C4水平有敏感的异常平面，伴有尿潴留和发热。紧急进行了颈椎和胸椎磁共振成像（MRI）检查，发现前方有液体积聚，导致继发性脊髓受压，符合脊髓硬膜外脓肿（SEA）。颈椎硬膜外脓肿是一种罕见但可能危及生命的疾病，可导致迅速且不可逆的神经功能恶化。通过这个临床病例，作者强调了临床怀疑、跨学科和协调工作在硬膜外脓肿诊断中的相关性，这是一种时间紧迫的急症。
