Zusammenfassung
Wir berichten über eine 70-jährige Patientin mit akut aufgetretenen, heftigen Kopfschmerzen, Meningismus, xanthochromem Liquor und einer im Verlauf ansteigenden Infektkonstellation in den Blutuntersuchungen. Nach initialem Verdacht und Diagnostik bezüglich einer Subarachnoidalblutung wurde kernspintomographisch ein hochzervikaler spinaler epiduraler Abszess, ausgehend von einer Osteomyelitis des Dens, nachgewiesen. Unter einer breiten systemischen Antibiose trat eine Abkapselung des entzündlichen Prozesses ein, was eine operative Sanierung ermöglichte. Die für die Diagnose ungewöhnlich kranial betonten Beschwerden, die initial an eine Subarachnoidalblutung denken ließen, sind vermutlich durch die Miteinbeziehung des kraniozervikalen Übergangs bedingt. Der zervikale spinale epidurale Abszess stellt eine gefährliche bakterielle Infektion der oberen Spinalachse dar. Bei inadäquater Behandlung drohen irreversible neurologische Ausfälle. Prognostisch entscheidend ist der frühzeitige Nachweis. Zur Diagnosestellung eignet sich insbesondere die kontrastmittelverstärkte spinale Kernspintomographie.
Summary
We report on a 70-year-old female with acute onset of headache, meningism, xanthochromic cerebrospinal fluid, and developing laboratory parameters indicating a systemic infection. Initially, a subarachnoidal hemorrhage was assumed. However, magnetic resonance imaging showed upper cervical osteomyelitis and extending spinal epidural abscess. After application of broad systemic antibiotics, secluded abscess formation was achieved and successful neurosurgical debridement performed. The unusual cranial concentration of the complaints is probably due to the involvement of the craniocervical transition. Cervical epidural spinal abscess represents a potentially dangerous bacterial infection of the upper spine. Inadequate treatment can lead to irreversible neurological deficits. Cervical magnetic resonance imaging is an effective tool for diagnosis, since early diagnosis is important for good prognosis.
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Richter, S., Reichert, N., Roos, U. et al. Akute Zephalgie mit Meningismus und xanthochromem Liquor. Nervenarzt 74, 699–703 (2003). https://doi.org/10.1007/s00115-003-1540-3
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DOI: https://doi.org/10.1007/s00115-003-1540-3