Acute headache with meningism and xanthochromic cerebrospinal fluid. An unusual manifestation of cervical epidural abscess

We report on a 70-year-old female with acute onset of headache, meningism,xanthochromic cerebrospinal fluid, and developing laboratory parameters indicating a systemic infection. Initially,a subarachnoidal hemorrhage was assumed. However,magnetic resonance imaging showed upper cervical osteomyelitis and extending spinal epidural abscess. After application of broad systemic antibiotics, secluded abscess formation was achieved and successful neurosurgical debridement performed. The unusual cranial concentration of the complaints is probably due to the involvement of the craniocervical transition. Cervical epidural spinal abscess represents a potentially dangerous bacterial infection of the upper spine. Inadequate treatment can lead to irreversible neurological deficits. Cervical magnetic resonance imaging is an effective tool for diagnosis, since early diagnosis is important for good prognosis.