Cervical Osteomyelitis With Epidural Abscess Overlooked In A Patient With Migraine And Idiopathic Intracranial Hypertension: A Case Report
Abstract
In patients with migraine or idiopathic intracranial hypertension (IIH) a worsening headache can often be attributed to an increase in intracranial pressure. Associated symptoms like new onset or worsening neck pain may be masked by this diagnosis, delaying identification of other serious conditions like cervical osteomyelitis. We present a female in her thirties with a medical history of episodic migraine, idiopathic intracranial hypertension without papilledema (IIHWOP), and type two diabetes mellitus, who developed worsening headaches with neck pain, photophobia, vertigo, and weight loss. Standard migraine therapies were ineffective. Neurological exams, fundoscopy, brain and vascular imaging, and lumbar puncture were unremarkable. A cervical spine MRI revealed findings consistent with cervical osteomyelitis and an epidural abscess. Cultures confirmed methicillin-resistant Staphylococcus aureus (MRSA). She was treated with antibiotics and monitored by infectious disease and neurology. Follow-up imaging showed improvement, and she continued conservative treatment with close specialist follow-up. This case underscores the importance of maintaining a broad differential diagnosis in patients with worsening headache features, particularly when associated with red flag symptoms such as neck pain and systemic signs, to avoid delays in diagnosing potentially life-threatening conditions such as spinal infections.
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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