MRI spinal cord compression — SCE Neurology MCQ

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HardNeurological InvestigationsMRI spinal cord compressionSCE Neurology

A patient has fever, severe focal thoracic pain, rapidly progressive paraplegia and urinary retention. MRI shows a rim-enhancing epidural collection compressing the cord at T6. Blood cultures are obtained. What is the next management?

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Correct answer: D — Immediate intravenous antibiotics and spinal surgical assessment

The best answer is “Immediate intravenous antibiotics and spinal surgical assessment”. A spinal epidural abscess with neurological deficit is a time-critical infectious compression; blood and operative cultures should guide therapy, but antibiotics and urgent decompression assessment must not be delayed when function is deteriorating. “Await image-guided culture before treating neurological decline” is less appropriate because delayed antimicrobial and source-control treatment risks irreversible cord injury and sepsis “Lumbar puncture through the region of epidural infection” is less appropriate because lumbar puncture is unnecessary, may spread infection and does not relieve compression “Oral analgesia with urgent outpatient infection follow-up” is less appropriate because outpatient care is unsafe with evolving paraplegia and sepsis “Physiotherapy before antimicrobial or decompressive treatment” is less appropriate because rehabilitation cannot substitute for infection treatment and mechanical decompression

Reference: NICE NG127: Suspected neurological conditions — recommendations. https://www.nice.org.uk/guidance/ng127/chapter/Recommendations