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Abstract Details

Cervical Epidural Abscess Presenting as Acute Brachial Plexopathy: Case Report
Peripheral Nerve
P07 - (-)
056
BACKGROUND: Acquired brachial plexopathy from humerus or cervical osteomyelitis is well recognized in neonates. Brachial plexopathy in adults due to cervical epidural abscess has not been described in the literature.
DESIGN/METHODS: Case report.
RESULTS: 54 year-old male presented 10 days after acute onset of stabbing pain on right scapular region radiating to his arm with tingling, numbness and weakness in the right upper extremity. No fever, drug use or trauma. Examination showed right arm strength of 3/5 triceps, finger extension and FDI, 4/5 APB and wrist extension, 1/5 rhomboid (limited by pain). Mild right scapular winging. Other extremity muscles were 5/5. Decreased pinprick on the right hand and medial forearm. Reflexes equal bilaterally. EMG showed neurogenic recruitment of the triceps, EIP, FDI and supraspinatus without active denervation. CMAP and SNAP amplitudes were normal. A clinically diagnosis of acute brachial plexopathy was made. Brachial plexus MRI was unremarkable. Cervical spine MRI showed epidural abscess posterior to C7 vertebral body with cord compression, osseous injury; and soft tissue/muscle injury of the right anterior and middle scalene muscles from C5 to T2 levels with poor nerve root delineation in that region. He underwent laminectomy. Surgical site cultures grew MSSA. Blood cultures were negative, echocardiogram showed no vegetations. He received 6 weeks of nafcillin IV. At 7 weeks there was improvement of right upper extremity strength and pain. MRI showed decrease enhancement of the C6-C7 right facet, T1 vertebral body and epidural space.
CONCLUSIONS: Cervical epidural abscess can mimic acute brachial plexopathy in his presentation. Cervical MRI should be considered in patients with acute brachial plexopathy since the treatment and prognosis are different and surgical intervention is usually needed.
Authors/Disclosures

PRESENTER 		No disclosure on file
Miguel Chuquilin Arista, MD, FAAN Dr. Chuquilin Arista has received personal compensation in the range of $500-$4,999 for serving as a Item writer with 好色先生. Dr. Chuquilin Arista has received personal compensation in the range of $500-$4,999 for serving as a Item Writer with 好色先生. Dr. Chuquilin Arista has received personal compensation in the range of $500-$4,999 for serving as a Item Writer with 好色先生. Dr. Chuquilin Arista has received personal compensation in the range of $500-$4,999 for serving as a Item reviewer with National Board of Medical Examiners. Dr. Chuquilin Arista has received personal compensation in the range of $500-$4,999 for serving as a Southeast regional advisory board with Argenx. Dr. Chuquilin Arista has received personal compensation in the range of $500-$4,999 for serving as a Focus group with Alexion. Dr. Chuquilin Arista has received personal compensation in the range of $0-$499 for serving as a Speaker with Periodic Paralysis Association.
No disclosure on file