Abstract
Intramedullary spinal cord abscess (ISCA) without meningitis is an extremely rare entity in the central nervous system, and it is often difficult to diagnose immediately, and no definitive imaging findings have been established. We experienced the case of a 61-year-old male who presented with a sudden onset back pain without fever following rapidly worsening paraparesis for 3 days, who subsequently become unable to walk. According to the initial MRI and 3D-CTA, the presumptive diagnosis was spinal infarction due to spinal artery embolism. However, his symptoms did not improve, despite the gradual changes in MRI following antiplatelet therapy. He underwent a biopsy in an attempt to prevent the lesion from progressing toward the upper spinal cord. The pathological examination revealed an intramedullary abscess, so we performed a midline myelotomy and drained the pus from the abscess. After surgery, MRI showed improvement, but the patient’s paraplegia persisted. To the best of our knowledge, this is the first case report of spinal cord abscess with the confirmation of spinal artery occlusion on angiography, which could have been caused by a bacterial embolism. We herein discuss its possible etiology and also review recent reports on ISCA.
References
Amacher AL (1992) Intramedullary epidermoid associated with an intramedullary abscess secondary to a dermal sinus [letter]. Neurosurgery 31:979
Applebee A, Ramundo M, Kirkpatrick BD, Fries TJ, Panitch H et al (2007) Intramedullary spinal cord abscess in a healthy woman. AAN 68:1230
Arzt PK (1944) Abscess within the spinal cord: review of the literature and report of three cases. Arch Neurol Psychiatry 51:533–543
Babu R, Jafa JJ, Huang PP, Budzilovich GN, Ransohoff J et al (1992) Intramedullary abscess associated with a spinal cord ependymoma: case report. Neurosurgery 30:121–124
Bartels RHMA, Gonera EG, Van der Sperk JAN, Thijssen HOM, Mullaart RA, Gabreels FJM et al (1995) Intramedullary spinal cord abscess: a case report. Spine 20:1199–1204
Bean JR, Walsh JW, Blacker HM et al (1979) Cervical dermal sinus and intramedullary spinal cord abscess: case report. Neurosurgery 5:60–62
Benzil DL, Epstein MH, Knuckey NW et al (1992) Intramedullary epidermoid associated with an intramedullary spinal abscess secondary to a dermal sinus. Neurosurgery 30:118–120
Blacklock JB, Hood TW, Maxwell RE et al (1982) Intramedullary cervical spinal cord abscess: case report. J Neurosurg 57:270–273
Byrne RW, Von Roenn KA, Whisler WW et al (1994) Intramedullary abscess: a report of two cases and a review of the literature. Neurosurg 35:321–326
Carus MEM, Anciones B, Castro A, Lara M, Isla A et al (1992) Intramedullary spinal cord abscess. J Neurol Neurosurg Psychiatry 55:225–226
Chan CT, Gold WL et al (1998) Intramedullary abscess of the spinal cord in the antibiotic era: clinical features, microbial etiologies, trends in pathogenesis, and outcomes. Clin Infect Dis 27:619–626
Chidambaram B, Balasubramaniam V et al (2001) Intramedullary abscess of the spinal cord. Pediatr Neurosurg 34:43–44
Chu JY, Montanera W, Willinsky RA (1996) Listeria spinal cord abscess-clinical and MRI findings. Can J Neurol Sci 23:220–223
Cokca F, Meco O, Arasil E, Unlu A (1994) An intramedullary dermoid cyst abscess due to Brucella abortus biotype 3 at T11–L2 spinal levels. Infection 22:359–360
Crema MD, Pradel C, Marra MD, Arrive L, Tubiana JM et al (2007) Intramedullary spinal cord abscess complicating thoracic spondylodiscitis caused by Bacteroides fragilis. Skeletal Radiol 36:681–683
David C, Brasme L, Peruzzi P, Bertault R, Vinsonneau M, Ingrand D et al (1997) Intramedullary abscess of the spinal cord in a patient with a right-to-left shunt: case report. Clin Infect Dis 24:89–90
Derkinderen P, Duval X, Bruneel F, Laissy JP, Regnier B (1998) Intramedullary spinal cord abscess associated with cervical spondylodiskitis and epidural abscess. Scand J Infect Dis 30:618–619
Desai KI, Muzumdar DP, Goel A et al (1999) Holocord intramedullary abscess: an unusual case with review of literature. Spinal Cord 37:866–870
DiTullio MV (1977) Intramedullary spinal abscess: a case report with a review of 53 previously described cases. Surg Neurol 7:351–354
Durmaz R, Atasoys MA, Durmaz G, Adapinar B, Arslantas A, Aydinli A, Tel E et al (2001) Multiple nocardial abscess of cerebrum, cerebellum and spinal cord, causing quadriplegia. Clin Neurol Neurosurg 103:59–62
Elmaci I, Kurtkaya O, Peker S, Tuncer N, Adam B, Ozgen S, Ekinci G, Ture U, Pamir N et al (2001) Cervical spinal cord intramedullary abscess. Case report. J Neurosurg Sci 45:213–215
Erlich JH, Rosenfeld JV, Fuller A, Brown GV, Wodak J, Tress BP et al (1992) Acute intramedullary spinal cord abscess: case report. Surg Neurol 38:287–290
Fernandez RM, Lopez MF, Garcia MM, Hornedo MJ, Aguado JM et al (2009) Intramedullary cervical spinal cord abscess by viridans group Streptococcus secondary to infective endocarditis and facilitated by previous local radiotherapy. Intern Med 48(1):61–64
Fortuna A, Contratti F, DiLorenzo N et al (1979) Cervical intramedullary abscess: extirpation by means of microsurgical techniques. J Neurosurg Sci 23:159–162
Gero B, Sze G, Sharif H et al (1991) MR imaging of intradural inflammatory disease of the spine. AJNR 12:1009–1019
Guzel N, Eras M, Guzel DK et al (2003) A child with spinal intramedullary abscess. Childs Nerv Syst 19:773–776
Hardwidge C, Palsingh J, Williams B et al (1993) Pyomelia: an intramedullary spinal abscess complicating lumbar lipoma with spina bifida. Br J Neurosurg 7:419–422
Hart J (1830) Case of encysted abscess in the center of the spinal cord. Dublin Hosp Rep 5:522–524
Helvaci M, KasIrga E, Cetin N, Yaprak I et al (2002) Intramedullary spinal cord abscess suspected of Brucella infection. Pediatr Int 44:446–448
Hott JS, Horn E, Sonntag VK, Coons SW, Shetter A et al (2003) Intramedullary histoplasmosis spinal cord abscess in a nonendemic region: case report and review of the literature. J Spinal Disord Tech 16(2):212–215
King SJ, Jeffree MA et al (1993) MRI of an abscess of the cervical spinal cord in a case of Listeria monocytogenes meningoencephalomelitis. Neuroradiology 35:495–496
Koppel BS, Daras M, Duffy KR et al (1990) Intramedullary spinal cord abscess. Neurosurgery 26:145–146
Kurisu K, Hida K, Yano S, Yamaguchi S, Motegi Y, Kubota K, Iwasaki Y et al (2008) The case of a large intra and extra medullary abscess of the spinal cord due to dermal sinus. No Shinkei Geka (Jpn) 36(12):1127–1132
Kurita N, Sakurai Y, Taniguhi M, Terao T, Takahashi H, Mannen T (2009) Intramedullary spinal cord abscess treated with antibiotic therapy: case report and review. Neurol Med Chir 49:262–268
Lascux AS, Chevalier X, Brugieres P, Levy Y et al (2002) Painful neck stiffness secondary to an intramedullary abscess of the spinal cord in a HIV infected patient: a case report. J Neurol 249:229–230
Maheswaran J, Rathinam PV, Lakshimi S, Inbasekaran V et al (1991) Intramedullary spinal cord abscess complicating a dermal sinus. J Indian Med Assoc 89:277
Marwah RK, Khosla VK, Agarwal KC, Kataria S et al (1985) Intramedullary spinal cord abscess. Indian Pediatr 22:71–74
Maurice-Williams RS, Pamphilon D, Coakham HB et al (1980) Intramedullary abscess—a rare complication of spinal dysraphism. J Neurol Neurosurg Psychiatry 37:242–244
Menezes AH, Graf CJ, Perret GE et al (1977) Spinal cord abscess: a review. Surg Neurol 8:461–467
Morandi X, Mercier P, Fournier HD, Brassier G et al (1999) Dermal sinus and intramedullary spinal cord abscess. Report of two cases and review of the literature. Childs Nerv Syst 15:202–208
Morimoto K, Takemoto O, Nakamura H, Takeuchi M et al (2003) Spinal dermal sinus associated with intramedullary abscess and dermoid. Pediatr Neurosurg 39:225–226
Morrison CR, Brown J, Gooding RS et al (1980) Spinal cord abscess caused by Listeria monocytogenes. Arch Neurol 37:242–244
Mukunda BN, Shekar R, Bass S et al (1999) Solitary spinal intramedullary abscess caused by Nocardia asteroids. South Med J 92:1223–1224
Murphy KJ, Brunberg JA, Quint DJ, Kazanjian PH et al (1998) Spinal cord infection: myelitis and abscess formation. Am J Neuroradiol 19:341–348
Novati R, Vigano MG, de Bona A, Nocita B, Finazzi R, Lazzarin A (2002) Neurobrucellosis with spinal cord abscess of the dorsal tract: a case report. Int J Infect Dis 6:149–150
Pfadenhauer K, Rossmanith T et al (1995) Spinal manifestation of neuroliseriosis. J Neurol 242:153–156
Rogg JM, Benzil DL, Hass RL, Knuckey NW et al (1993) Intramedullary abscess: an unusual manifestation of a dermal sinus. Am J Neuroradiol 14:1393–1395
Seizeur R, Condette-Auliac S, Goutagny S, Pencalet P, Gaillard S (2006) Chronic intramedullary abscess (Streptococcus sanguis). A case report and review of the literature. Neurochirurgie 52(6):542–546
Simon JK, Lazareff JA, Diament MJ, Kennedy WA (2003) Intramedullary abscess of the spinal cord in children: a case report and review of the literature. Pediatr Infect Dis J 22:186–192
Sverzut JM, Laval C, Smadja P, Gigaud M, Sevely A, Manelfe C et al (1998) Spinal cord abscess in a heroin addict case report. Neuroradiology 40:455–458
Tewari MK, Devi BI, Thakur RC, Pathak A, Khandelwal N, Kak VK et al (1992) Intramedullary spinal cord abscess; a case report. Childs Nerv Syst 38:287–290
Tsurubuchi T, Matsumura A, Nakai K, Fujita K, Enomoto T, Iwasaki N, Nose T et al (2002) Reversible holocord edema associated with intramedullary spinal abscess secondary to an infected dermoid cyst. Pediatr Neurosurg 37:282–286
Vajramani GV, Ngmoti MB, Patil CS et al (2005) Neurobrucellosis presenting as an intra-medullary spinal cord abscess. Ann Clin Microbiol Antimicrob 4:14
Vora YA, Raad II, McCutcheon IE (2004) Intramedullary abscess from group F Streptococcus. Surg Infect [Larchmt] 5:200–204
Weng TI, Shih FY, Chen WJ, Lin FY (2001) Intramedullary abscess of the spinal cord. Am J Emerg Med 19:177–178
Yuceer N, Senoglu M, Arda MN (2004) Intramedullary spinal cord abscess in a 4-year old child. Acta Neurochir [Wien] 146:1273–1274
Mori K, Miwa K, Hara S, Nakashima T, Ueda T, Yokoyama K, Sakai N (2003) A case of a bacterial brain abscess presenting as symptoms of ‘sudden stroke-like’ onset. Noshinkei Geka 31(4):443–448
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Iwasaki, M., Yano, S., Aoyama, T. et al. Acute onset intramedullary spinal cord abscess with spinal artery occlusion: a case report and review. Eur Spine J 20 (Suppl 2), 294–301 (2011). https://doi.org/10.1007/s00586-011-1703-z
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DOI: https://doi.org/10.1007/s00586-011-1703-z