Intramedullary Abscess of the Spinal Cord in the Setting of Patent Foramen Ovale

Spinal Cord Infarction and Patent Foramen Ovale: Is There a Link

“…PFO has also been linked with cryptogenic brain abscess, and some studies have shown the co-occurrence of PFO with intramedullary abscesses of the spinal cord (IASC) [8, 9]. IASC is a rare condition that usually occurs secondary to bacteremia from cardiac, pulmonary or urinary foci.…”

“…IASC is a rare condition that usually occurs secondary to bacteremia from cardiac, pulmonary or urinary foci. Hoche demonstrated that the introduction of micro-organisms into the circulation of experimental animals did not result in the development of ISCA; however, if both microorganisms and thrombi were introduced, ISCA developed [9]. Therefore, spinal embolism is understood as a relevant disease mechanism.…”

“…Therefore, spinal embolism is understood as a relevant disease mechanism. Higuchi et al [8] and Terterov et al [9] identified Streptococcus viridians as the causative agent of IASC. This is a well-known oral low-pathogenicity agent that can cause transient asymptomatic bacteremia in healthy patients.…”

“…This is a well-known oral low-pathogenicity agent that can cause transient asymptomatic bacteremia in healthy patients. In their case report, Terterov et al [9] suggested that this transient bacteremia infected a subclinical deep vein thrombosis and the paradoxical embolism was facilitated by the patient PFO. The right-to-left shunting would allow pathogens to bypass pulmonary capillary filtering and enter arterial circulation easier.…”

“…This is not clearly established for SCI, as there are only 3 reported cases of SCI associated with a PFO [5, 6, 7]. However, right-to-left shunting has also been related to spinal infectious diseases by septic embolism [8, 9, 10]. We describe the case of a SCI associated with a PFO with a borderline ASA and discuss the possible role of right-to-left shunting on cryptogenic spinal infarction.…”