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Spinal epidural abscess — RCPSC EM MCQ

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HardNeurological emergenciesSpinal epidural abscessRCPSC EM

A 68-year-old with cancer presents with new back pain, fever and bilateral leg weakness. Temperature is 38.3°C, ESR is 92 mm/h and post-void residual is 650 mL. He has midline thoracic tenderness and reduced pinprick below T8. What is the most appropriate investigation?

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Correct answer: E — MRI whole spine with contrast

Back pain with fever, neurological deficit and urinary retention suggests spinal epidural abscess or malignant cord compression. MRI with contrast is the key investigation and must not be delayed.

Reference: Canadian neurological emergency practice; Rosen's Emergency Medicine