Cervical Intradural Abscess Masquerading as an Epidural Collection

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Intradural spinal cord abscesses especially in the cervical spine are a rare occurrence. We report a rare presentation of an intradural extramedullary abscess at the atlantoaxial level, initially misdiagnosed as an epidural collection. The patient presented with worsening quadriparesis preceded by a 2-week history of upper respiratory tract infection and neck pain. Magnetic resonance imaging showed evidence of an epidural abscess on the left side abutting the cervicomedullary junction. We performed occipitocervical fixation and surgical decompression. Absence of a suspected epidural abscess led us to consider a durotomy, and an intradural abscess was recognized and drained. Presence of an intradural abscess, though extremely rare, must always be considered in suspected spinal epidural collections as radiological and clinical findings are indistinguishable between the two conditions.