A 66yo diabetic female with a history of a recent febrile illness now presents with increasing weakness and altered sensation in both legs. A lumbar puncture is performed and the initial CSF result is shown.
|
Red blood cells |
594 x 106/L |
(0-5 x 106/L) (0-5 x 106/L) |
|
Mononuclear cells |
154 x 106/L |
|
|
Protein |
0.99g/L |
(0.15 – 0.40g/L) |
|
Glucose |
10.4 mmol/L |
(2.5-5.6 mmol/L) |
|
No organisms seen |
a). What is the most important diagnostic investigation indicated in this clinical scenario?
b). What is the most likely diagnosis?
a). What is the most important diagnostic investigation indicated in this clinical scenario?
MRI of the spine
b). What is the most likely diagnosis?
Epidural abscess
This elderly diabetic woman has a bilateral motor and sensory loss in her legs. The CSF looks infected; perhaps the glucose is raised, but this could be because the serum glucose is also raised, so I would not be deterred from a suspicion of epidural abscess by the presence of these findings.
The most important investigation in this context would be an MRI of the whole spine.
Reihsaus, E., H. Waldbaur, and W. Seeling. "Spinal epidural abscess: a meta-analysis of 915 patients." Neurosurgical review 23.4 (2000): 175-204.