0:01

I told you one of the calmest areas is spine,

0:04

and especially infections in the spine.

0:06

Sometimes we don't get good history,

0:08

but if you get a history such as this neck pain, fever,

0:12

arm weakness, all three are, are really good

0:17

like red flags in, in, in a patient.

0:20

So that, that's not like normally

0:22

how we get our histories most of the time these days.

0:25

But, but fever, arm weakness, that is,

0:28

that is very important.

0:29

So you are, once you, once you read fever, your, your

0:34

suspicion about infection information,

0:36

especially in the spine should be high

0:37

and completely cleared out.

0:39

So you can see that there's a protrusion at, uh, six seven.

0:44

It's, it's a emotionally scan Also,

0:46

we don't know if this is real or not.

0:48

Uh, it's hard to say,

0:49

but there is something brewing up behind that.

0:53

Uh, C two vertebra.

0:54

Again, this is not clear,

0:56

but there were other images

0:57

that were also obtained on this patient, uh,

0:59

especially the post contrast, which I'll show you.

1:02

Uh, but impression on this scan was this protrusion C six

1:06

seven level and this finding that was completely missed

1:10

that there is an epidural abscess, uh, at,

1:13

uh, in this patient.

1:15

So patient pain, fever, weakness, uh, was

1:21

read overnight by a trainee

1:24

and was read as pretty normal

1:26

with some degenerative changes.

1:27

Overall, final read was next day at 9:00 AM was read the

1:32

same way without any mention of

1:35

that epidural abscess patient's neurological status

1:39

kept on worsening.

1:40

So patient was transferred over to a tertiary care center.

1:44

Patient was operated 2.5 days

1:47

after the initial presentation in the, in the, uh,

1:50

in the first hospital.

1:52

Uh, and of, of course, this was an abscess, turned out

1:56

to be RS asepsis and after surgery

1:59

and all that is quadriplegic and, and wheelchair bound.

2:03

Uh, so be very, very careful when you get your histories,

2:07

uh, like that.

2:09

And, and this day

2:10

and age, we know how common, um, uh, spine infections,

2:14

DYS osteomyelitis are.