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Delayed diagnosis of odontoid peg osteomyelitis with bilateral X and XII cranial nerve palsies
  1. Faisal Bashir Chaudhry1,
  2. Samavia Raza2 and
  3. Usman Ahmad3
  1. 1 Department of Stroke Medicine, John Radcliffe Hospital, Oxford, UK
  2. 2 Radiology Department, John Radcliffe Hospital, Oxford, UK
  3. 3 Department of Gastroenterology, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
  1. Correspondence to Dr Faisal Bashir Chaudhry, faisalbchaudhry{at}


Upper cervical osteomyelitis is rare. Its presenting features are fever and neck pain, but rarely it can involve lower nerves. MRI is the main imaging modality, but it is difficult to interpret due to the unique anatomy of C1 and C2 vertebra and complex intervertebral joint. We describe a case of a 67-year-old woman, who presented with the complaint of loss of voice, neck pain and fever for 5 days. Despite repeated imaging of neck, the diagnosis was not reached. As the patient’s condition continued to deteriorate, clinical signs of bilateral 10th and 12th cranial nerve paralysis appeared and lead to a focused workup for base of skull pathology. Discussion with the radiologist helped guide the imaging protocol, which leads to the correct diagnosis being made. Treatment was tailored by blood cultures and available images. Temporary immobilisation with a cervical collar and a total of 12 weeks of antibiotics lead to complete remission.

  • radiology (diagnostics)
  • infections
  • musculoskeletal and joint disorders
  • bone and joint infections
  • cranial nerves

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  • Contributors FBC: was the main clinician involved in management of the case and has contributed to writing up the abstract, main stem of case report and discussion. SR: guided in radiological image interpretation, image selection, literature review and contributed to writing up discussion. UA: helped in literature review and contributed to writing up discussion and conclusion.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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