Comprehensive management of cervical epidural spinal abscess followed by brain abscesses: a life-threatening and tortuous case

Cervical epidural spinal abscess (C1-3) followed by intracranial infection is an extremely rare entity and life-threatening disease. For the very first time, we reported our clinical experience of managing such a life-threatening and tortuous case. A 58-year-old woman with neck pain was admitted to our hospital with the suspect of cervical tumor. Enhanced magnetic resonance (MRI) image demonstrated C1-3 suspected multiple abscess as well as extended inflammation of upper cervical and intracranial meninges. We conducted an urgent surgery with decompression, canaloplasty as well as debridement of the focus and then the patient was transferred to Surgical Intensive Care Unit. Head pain remained, but the intracranial infection was initially excluded. Subsequent MRI demonstrated extended endocranium lesions of middle and posterior fossa, as well as multifocal epidural abscesses. Multidisciplinary consultation was called and therapy plan was made by spine surgeons, neurosurgeons, ophthalmologists, cardiologists and infection physicians. After intrathecal injection of vancomacin for 14 + 7 days, as well as two-month administrations of a sequential order of antibiotics amoxicillin/sulbactam, levofloxacin, and fosfomycin. The patient was then successfully cured and discharged.