Cervical Epidural Abscess: A Blind Spot for Postmortem Computed Tomography

Am J Forensic Med Pathol. 2022 Sep 1;43(3):273-276. doi: 10.1097/PAF.0000000000000742. Epub 2021 Dec 23.


Spinal epidural abscess is an uncommon condition, which may have serious complications, including neurological sequelae and death. Classical symptoms include spinal pain, fever, and neurological deficit; however, diagnosis is difficult and requires a high degree of clinical suspicion. Antemortem magnetic resonance imaging (MRI) scanning is the gold-standard diagnostic tool. Computed tomography (CT) is less sensitive and as such, postmortem CT may miss the diagnosis. We report a case of Staphylococcus aureus cervical epidural abscess presenting as neck pain and causing flaccid paralysis and subsequently death. Antemortem MRI showed a small epidural collection, spinal cord edema, and fluid in the adjacent cervical disc and facet joints; however, these findings could not be appreciated on postmortem CT. Postmortem examination, guided by the antemortem imaging, was able to confirm a cervical spinal epidural abscess; however, similar deaths may occur before medical presentation. This case demonstrates a limitation of postmortem imaging in diagnosing spinal epidural abscess and highlights that such cases may be missed.

Publication types

  • Case Reports

MeSH terms

  • Epidural Abscess* / complications
  • Epidural Abscess* / diagnostic imaging
  • Epidural Space / diagnostic imaging
  • Humans
  • Magnetic Resonance Imaging
  • Staphylococcal Infections* / complications
  • Staphylococcal Infections* / diagnostic imaging
  • Staphylococcus aureus
  • Tomography, X-Ray Computed