Upper Extremity Paralysis Caused by an Internal Spinal Epidural Abscess that was not Identified on Imaging

We report the case of a 63‐year‐old male with diabetes who was diagnosed with staphylococcal bacteremia. Paralysis of the extremities (right upper, left lower) and bladder and bowel dysfunction developed 5 days after treatment initiation. Spinal magnetic resonance imaging revealed a spinal epidural abscess at the L4/5 level. Despite right upper extremity palsy, there was no visible cervical spine abscess. Emergency surgery was undertaken, which resulted in complete neurological recovery. General physicians must be aware that damage to the spinal cord can be caused not only by direct compression of an epidural abscess but also by impaired blood circulation or inflammation.