Spinal epidural haematoma misdiagnosed as meningitis

A 32-year-old man developed sudden onset neck pain while at work. There was no headache, fever and no history of head or neck injury, He had been in g ood health. He continued to work and went home after seeing his doctor, who diagnosed muscle strain. Four days later the pain persisted and he was adm itted to hospital, Examination revealed marked neck stiffness, generalized hyperreflexia but with preserved power and a fever of 38 degreesC. Urgent c omputed tomography of the brain was normal, The blood white cell count was normal. CSF analysis revealed red blood cells and some white blood cells, a blood-stained high protein count of 7 g/litre and a low glucose of 0.7 mmo l/litre. Simultaneous blood sugar consentration was 6.7 mmol/litre. A presu mptive diagnosis of meningitis was made and hewas stoned on cefotaxime. Blo od and CSF cultures were negative, Magnetic resonance scan of the spinal co rd 5 days later showed an acute epidural haematoma at T2-T5 with 40% cord s tenosis and cord oedema, He underwent posterior laminectomy For cord decomp ression; postoperative recovery was uneventful. A subsequent angiogram show ed no sign of arteriovenous malformation or tumour and he recovered fully.