Intramedullary Cervical Spinal Cord Abscess

Bakhsheshian, Joshua; Kim, Paul E.; Attenello, Frank J.

doi:10.1016/j.wneu.2017.06.121

Cited by 12 publications

(6 citation statements)

References 2 publications

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“…Clinically, intramedullary abscesses can present with acute neurological deficits, mimicking an episode of transverse myelitis [35]. More commonly, intramedullary abscesses have a presentation characterized by progressive dorsal pain followed by neurological deficits as was seen in our patients [14,29,36,37]. On occasion, the clinical presentation can be more insidious, mimicking a spinal tumor or other conditions capable of inducing chronic myelopathy [38].…”

Section: Discussionmentioning

confidence: 89%

“…Regarding treatment, the most common therapeutic approaches to intramedullary abscesses center on surgical decompression and myelotomy for abscess drainage with cavity content sampling for culture-guided antibiotic therapy yet reports of intramedullary abscesses managed non-operatively do exist [36,43]. For previously described intra-medullary abscesses caused by Streptococcus species, beta-lactams such as penicillin and ceftriaxone have been common antibiotic choices due to their excellent anti-streptococcal activity and CNS penetration [13][14][15][16][17].…”

Section: Discussionmentioning

confidence: 99%

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Spontaneous intramedullary abscesses caused by Streptococcus anginosus: two case reports and review of the literature

et al. 2022

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Background Intramedullary abscesses are rare infections of the spinal cord. Intramedullary abscesses often have a complex presentation, making a high index of suspicion essential for prompt diagnosis and management. Case presentation We present two cases of intramedullary abscesses referred to and ultimately managed at our institution. Delayed diagnosis occurred in both instances due to the rarity of intramedullary abscesses and their propensity to mimic other pathologies. For both patients, prompt surgical management and the rapid institution of broad-spectrum antibiotics were critical in preventing further neurological decline. Conclusions Although rare, it is critical to consider intramedullary abscesses on the differential for any MRI lesions that are hyperintense on T2 and peripherally enhancing on T1 post-contrast sequences, as even short delays in treatment can lead to severe neurological damage.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Spontaneous intramedullary abscesses caused by Streptococcus anginosus: two case reports and review of the literature

et al. 2022

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“…ISCA is a rare entity, even rarer when it is associated with a brain abscess. Our review of the literature suggests that ISCA mainly involves the cervical cord [1][2][3][5][6][7][8]]. An ISCA typically presents with progressive back pain with fever followed by neurological deficits, and it can also present with acute neurological deficits similar to episodes of transverse myelitis [3,6].…”

Section: Discussionmentioning

confidence: 99%

Intramedullary spinal cord abscess with brain abscess due to subacute infective endocarditis

et al. 2023

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Background Intramedullary spinal cord abscesses (ISCA) are rare, even more so in association with brain abscesses. Infective endocarditis is an uncommon cause of ISCA. In this case study, we report a patient with intramedullary abscesses and multiple brain abscesses due to subacute infective endocarditis. Case presentation A 54-year-old man presented with a 7-day history of head and neck pain and numbness in both lower limbs. Intramedullary abscess combined with multiple brain abscesses was diagnosed based on blood culture, head and spinal magnetic resonance imaging (MRI), contrast-enhanced MRI, and magnetic resonance spectroscopy. Echocardiography revealed vegetations on the mitral valve and severe mitral regurgitation, which the authors believe was caused by subacute infective endocarditis. With ceftriaxone combined with linezolid anti-infective therapy, the patient's symptoms and imaging was improved during follow-up. Conclusions This case hopes to raise the vigilance of clinicians for ISCA. When considering a patient with an ISCA, it is necessary to complete blood culture, MRI of the brain and spinal cord, and echocardiography to further identify whether the patient also has a brain abscess and whether the cause is infective endocarditis.

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“…2). 2,5,8,14,15,20,21 Neoplastic lesion cores, unlike ISCA, tend to display no signal on DWI or DWI hypointensity and high ADC signal intensity signifying necrosis, though diffusion restriction can rarely be seen in the case of an associated hematoma. 9 In this case, the degree of cord edema and the restricting lesion core provided sufficient evidence to proceed with surgical intervention with the goals of decompression, tissue diagnosis, and culture of the aspirate fluid.…”

Section: Discussionmentioning

confidence: 99%

Cryptogenic cervical intramedullary abscess with rapidly progressive myelopathy: illustrative case

Warsi

Wilson

Malhotra

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUNDThe purpose of the present case report is to highlight the presentation, workup, clinical decision making, and operative intervention for a 68-year-old woman who developed rapidly progressive myelopathy secondary to idiopathic cervical intramedullary abscess.OBSERVATIONSThe patient underwent laminectomy and aspiration/biopsy of the lesion. Intraoperatively, division of the posterior median sulcus released a large volume of purulent material growing the oral pathogens Eikenella corrodens and Gemella morbillorum. Broad-spectrum antibiotics were initiated postoperatively. At the 6-month follow-up, the patient had almost completely recovered with some persistent hand dysesthesia. Complete infectious workup, including full dental assessment and an echocardiogram, failed to reveal the source of her infection.LESSONSThe authors report the first case of cryptogenic spinal intramedullary abscess secondary to Eikenella spp. and Gemella spp. coinfection. Intramedullary abscesses are exceptionally rare and most commonly develop in children with dermal sinus malformations or in the context of immunosuppression. In adults without risk factors, they can readily be mistaken for more common pathologies in this age group, such as intramedullary neoplasms or demyelinating disease. Prompt diagnosis and management based on rapidly progressive myelopathy, assessment of infectious risk factors and/or symptoms, and targeted imaging are critical to avoid potentially devastating neurological sequelae.

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Intramedullary Cervical Spinal Cord Abscess

Cited by 12 publications

References 2 publications

Spontaneous intramedullary abscesses caused by Streptococcus anginosus: two case reports and review of the literature

Spontaneous intramedullary abscesses caused by Streptococcus anginosus: two case reports and review of the literature

Intramedullary spinal cord abscess with brain abscess due to subacute infective endocarditis

Cryptogenic cervical intramedullary abscess with rapidly progressive myelopathy: illustrative case

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