TITLE:
Compressive Myelopathy, Spinal Shock, and a Complicated Neurological Exam
AUTHORS:
Haroutiun Hamzoian, Christine Ochoa, Lekhraj Patel, Kwabena Ayesu
KEYWORDS:
Compressive Myelopathy, Spine, Spinal Epidural Abscess, Spinal Imaging, Neurological Examination, Neurology, Neurosurgery, Abscess, Neuroimaging
JOURNAL NAME:
Surgical Science,
Vol.14 No.10,
October
11,
2023
ABSTRACT: The neurological examination, developed and tested since the 1800s has
provided physicians with a vital tool to rapidly assess and provide clues to
many of the pathological processes lurking inside the brain and spinal cord.
With the advent of magnetic resonance imaging, physicians are able to visualize the precise location of the abscess before surgical
intervention. In this case report, we present a 51-year-old male with an
epidural abscess with multifocal compressive myelopathy, resulting in a
complicated neurological examination, making localization a diagnostic
challenge. With this case, we would like to stress that complicated multifocal
lesions of the cord may present with a large variation in examination findings.
This patient’s neurological exam was complicated secondary to a ventrally as
well as dorsally located epidural abscess with superimposed spinal shock
sequelae. We would like to highlight the importance of a thorough history and
the neurological examination but also mention some of its limitations. It is
crucial to use clinical judgement to navigate the patient’s history,
presentation, and examination to accurately diagnose and treat, particularly so
in cases involving compressive myelopathies of the spinal cord.