Abstract
Spinal epidural abscess (SEA) is a rare disease and has a poor prognosis if the diagnosis is delayed. Early diagnosis leads to a favorable prognosis, but the diagnosis is difficult, especially in the early stage when neurological deficits are not apparent. We report two cases of cervical SEA that had problems of differential diagnosis from retropharyngeal abscess. Case 1：A 76-year-old woman. She was receiving medication therapy for acute sphenoiditis, but developed progressive neurological deficit. MRI showed spinal cord swelling and apparent retropharyngeal abscess. However, contrast-enhanced CT revealed that the abscess was located in the prevertebral muscles of the neck, not in the retropharyngeal space. We diagnosed cervical spinal epidural abscess. Antibiotic therapy was performed, but she did not fully recover. Case 2：A 41-year-old man. He had back pain, and head MRI suggested retropharyngeal abscess. Endoscopy showed no pharyngeal swelling, and contrast-enhanced CT revealed that the abscess was located in the prevertebral space. Gadolinium contrast MRI elucidated that the infection might have spread from spondylodiscitis. Antibiotic therapy was performed successfully. For the diagnosis of cervical SEA and the differential diagnosis of retropharyngeal abscess, contrast-enhanced CT, in addition to MRI, should be performed.
