Intramedullary Spinal Cord Abscess: Illustration of Two Cases and Review of Literature

Abstract

Intramedullary spinal cord abscess is a rare infection of the spinal cord with less than 120 cases reported since its first description by Hart in 1830. It is usually associated with abnormalities of the spinal cord or documented source of infection or immunodeficiency, requiring clinical radiological suspicion for accurate diagnosis. The first case is a middle-aged healthy woman without any underlying risk factors, presented with progressive paraparesis, in whom prompt, accurate diagnosis with contrast magnetic resonance imaging, diffusion-weighted imaging, and apparent diffusion coefficient mapping followed by early surgery was possible, which resulted in the favorable neurological outcome. The second case is a 10-year-old boy with paraparesis whose definite treatment and surgery was delayed due to a delay in accurate clinical and radiological diagnosis which resulted in poor outcomes. Hence, we try to establish that prompt diagnosis and surgical treatment can result in a favorable neurological outcome, though the prognosis, in general, is poor in this clinical condition. A review of literature in support of our cases is given.

Intramedullary Spinal Cord Abscess with Concomitant Spinal Degenerative Diseases: A Case Report and Systematic Literature Review

“…Byrne et al discovered that 36% of intramedullary abscesses primarily involved the cervical cord, 36% the conus, and 29% the thoracic cord, whereas lower thoracic and lumbar segments are the common sites in congenital midline defects [ 4 ]. In previous studies, intramedullary spinal cord abscesses mostly involved the cervical and upper segments of the thoracic cord [ 74 ]. In our review, twenty-five abscesses (35.71%) primarily involved the cervical cord, nineteen (27.14%) the thoracic cord, three (4.2%) the lumbar cord, eight (11.42%) cervical to thoracic, eight (11.42) thoracic to lumbar, one (1.42%) lumbar to sacral and holocord, and two (2.85%) the conus; four cases had multiple abscesses (see Figure 6 ).…”

“…Additionally, around 25% of cases were from contiguous spread of infection from dermal sinus tracts. Predisposing factors in pediatric ISCA include congenital midline defects and anatomical abnormalities of the spinal cord or vertebral column [ 74 ]. This shift in pathogenesis is likely to be related to the wide availability of effective antimicrobial agents to treat the primary sites of infection.…”

What Is Currently Known about Intramedullary Spinal Cord Abscess among Children? A Concise Review

“…In our literature search, dermal sinus sinuses were observed in 35 (54.68%) children. The causative organisms among these patients include the microorganisms colonizing the skin surrounding the sinus tract openings [ 66 ].…”