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In the case of the patient with interscapular pain (JW Neurol Mar 31 2009), the treating clinician initially suspected that the cause of the myelopathy was ischemic, given that the patient has diabetes and atrial fibrillation. However, inflammatory markers were significantly elevated. The local spinal tenderness was important. The MRI scan showed an extradural abscess extending from cervical level 5 to thoracic level 9 (see image). During surgery, pus was drained from the extradural space, from which Staphylococcus aureus was cultured. Postoperatively, the patient received antibiotics and neurological improvement was noted 1 week later.
Lessons learned: The diagnosis of myelopathy was delayed because the symptoms could not be localized to a …
