1. Delayed diagnosis of odontoid peg osteomyelitis with bilateral X and XII cranial nerve palsies.
- Author
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Chaudhry FB, Raza S, and Ahmad U
- Subjects
- Aged, Bacterial Infections therapy, Cervical Vertebrae microbiology, Cranial Nerve Diseases diagnostic imaging, Cranial Nerve Diseases therapy, Delayed Diagnosis, Female, Humans, Immobilization, Magnetic Resonance Imaging, Neck Pain, Odontoid Process diagnostic imaging, Odontoid Process microbiology, Osteomyelitis diagnostic imaging, Osteomyelitis therapy, Tomography, X-Ray Computed, Treatment Outcome, Voice Disorders, Anti-Bacterial Agents therapeutic use, Bacterial Infections pathology, Cervical Vertebrae pathology, Cranial Nerve Diseases pathology, Odontoid Process pathology, Osteomyelitis pathology
- Abstract
Upper cervical osteomyelitis is rare. Its presenting features are fever and neck pain, but rarely it can involve lower nerves. MRI is the main imaging modality, but it is difficult to interpret due to the unique anatomy of C1 and C2 vertebra and complex intervertebral joint. We describe a case of a 67-year-old woman, who presented with the complaint of loss of voice, neck pain and fever for 5 days. Despite repeated imaging of neck, the diagnosis was not reached. As the patient's condition continued to deteriorate, clinical signs of bilateral 10th and 12th cranial nerve paralysis appeared and lead to a focused workup for base of skull pathology. Discussion with the radiologist helped guide the imaging protocol, which leads to the correct diagnosis being made. Treatment was tailored by blood cultures and available images. Temporary immobilisation with a cervical collar and a total of 12 weeks of antibiotics lead to complete remission., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2019
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