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How good at neurology are you?—ANSWERS

1. There is a bony destructive process, centred on the right C7/T1 facet joint. Swelling and high signal can be seen within the paracervical musculature and upper parathoracic area, with enhancement. Other magnetic resonance images showed this process, with abnormal signal, extending into the spinal canal, with minor compression of the spinal cord at C7/T1. The radiologist reported no abscess formation, soft tissue calcification, or discitis. One needle and two open biopsies were required before a diagnosis of staphylococcal aureus infection was established. No remote source of infection was ever identified, in particular the patient vehemently denied iv drug abuse—common to many of the published cases of cervical vertebral osteomyelitis. She was treated with seven weeks of high dose iv flucloxacillin, followed by six months of oral anti-staphylococcal therapy. Neurological findings resolved completely but only towards the end of antimicrobial therapy. A stiff neck persisted.
   Cervical vertebral osteomyelitis, with or without . . . [Full text of this article]