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Vo DT, Cravens GF, Germann RE. Streptococcus pneumoniae meningitis complicated by an intramedullary abscess: a case report and review of the literature. J Med Case Rep 2016; 10:290. [PMID: 27756423 PMCID: PMC5069864 DOI: 10.1186/s13256-016-1080-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 09/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intramedullary abscess is a rare neurosurgical condition that usually arises in the setting of penetrating trauma to the spinal cord, infected congenital dural sinuses, or tuberculosis. CASE PRESENTATION We describe a case of a 35-year-old African American male who presented with sepsis and a clinical picture of meningitis. The patient continued to have declining neurological status with decreasing sensation and worsening motor strength in all four extremities. He was found to have an intramedullary abscess in the cervical spinal cord that was treated with a decompressive posterior cervical laminectomy and drainage. The patient began to have a partial recovery of neurological function postoperatively. We also review the literature on intramedullary abscess that suggests the clinical presentation of our patient was a rare complication of acute meningitis. CONCLUSIONS Intramedullary abscess formation is a rare entity, and a high index of suspicion for intramedullary abscess is the key for making the diagnosis and expediting treatment for these patients.
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Affiliation(s)
- Dat T Vo
- Department of Pediatrics, John Peter Smith Hospital, 1500 South Main Street, Fort Worth, TX, 76104, USA. .,Department of Neurosurgery, John Peter Smith Hospital, 1500 South Main Street, Fort Worth, TX, 76104, USA. .,The Center for Neurological Disorders, 1010 Houston Street, Fort Worth, TX, 76102, USA. .,Department of Radiation Oncology, The University of Texas Southwestern Medical Center, 5801 Forest Park Road, Dallas, TX, 75390, USA.
| | - George F Cravens
- Department of Neurosurgery, John Peter Smith Hospital, 1500 South Main Street, Fort Worth, TX, 76104, USA.,The Center for Neurological Disorders, 1010 Houston Street, Fort Worth, TX, 76102, USA
| | - Robert E Germann
- Department of Neurosurgery, John Peter Smith Hospital, 1500 South Main Street, Fort Worth, TX, 76104, USA.,The Center for Neurological Disorders, 1010 Houston Street, Fort Worth, TX, 76102, USA
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Group F Streptococcus. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0000000000000121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bukhari EE, Alotibi FE. Fatal Streptococcus melleri meningitis complicating missed infected intramedullary dermoid cyst secondary to dermal sinus in a Saudi child. J Trop Pediatr 2013; 59:246-9. [PMID: 23292742 DOI: 10.1093/tropej/fms073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A spinal intramedullary abscess secondary to an infected dermoid cyst is rare, and it has a poor prognosis, unless diagnosed and treated promptly. We report a 12-month-old patient with a spinal intramedullary abscess with secondary to a dermoid cyst resulting from a dermal sinus, despite a clearly defined opening at the lower back with discharge of a purulent material from a dermal sinus tract seen on the lower back before the patient had become symptomatic and showed meningeal signs. The patient was managed as a case of meningitis until he had complications that endangered his life, and then further radiological evaluation was done to delineate the underlying pathology. This case illustrates the importance of the recognition and evaluation of skin markers because of the potential for intradural extension and a frequent association with other dysraphic abnormalities. It also emphasizes the importance of early diagnosis and treatment of spinal intramedullary abscess.
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Affiliation(s)
- Elham Essa Bukhari
- Pediatric Department, Infectious Disease Division, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia 11461.
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Madhugiri VS, Gundamaneni SK, Santosh V, Jagadisan B, Sasidharan GM, Roopesh-Kumar RV, Yadav AK, Singh M, Ananthakrishnan R, Pariarath N, Biswal N. Acute pyogenic necrotizing encephalomyelitis: a fulminant and fatal infection. J Neurosurg Pediatr 2013; 11:591-5. [PMID: 23495810 DOI: 10.3171/2013.2.peds12446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this report the authors describe a rare case of a fulminant, pyogenic, necrotizing infection of the spinal cord and brain. Necrotizing lesions of the brain and spinal cord are usually infectious in origin and are associated with high rates of morbidity and death. Although the pathogens responsible have been identified in a few instances, the causal factors remain unknown in many cases. An 11-year-old girl developed acute, rapidly progressive paraplegia with bladder involvement and sensory loss below T-10. She had been treated recently for a Staphylococcus aureus infection of the knee joint precipitated by a penetrating injury with organic matter in the aftermath of a cyclone. Although appropriate antibiotic therapy was instituted, the spinal cord infection progressed to involve the entire spinal cord, brainstem, and brain. This fulminant course was marked by a rapid deterioration in the patient's clinical condition, ultimately leading to her death. Magnetic resonance imaging demonstrated a previously undescribed pattern of longitudinal enhancement along the spinal cord, as well as the white matter tracts in the brainstem and brain. The possible route of spread of infection along the neuraxis is postulated to be the potential space along the white matter tracts. Treatment is not standardized due to the rarity of the condition.
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Affiliation(s)
- Venkatesh Shankar Madhugiri
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.
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Akhaddar A, Boulahroud O, Boucetta M. Chronic spinal cord abscess in an elderly patient. Surg Infect (Larchmt) 2011; 12:333-4. [PMID: 21859339 DOI: 10.1089/sur.2010.064] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Spinal cord abscesses are rare. Acute lesions may present as spinal cord syndrome with back pain and fever, whereas chronic abscesses tend to have a less specific symptomatology, especially in elderly patients. METHODS Case report and review of the pertinent literature. CASE REPORT An 82-year old male with diabetes mellitus presented with a four-month history of backache and some difficulty walking without sphincter disturbance or fever. Spinal magnetic resonance imaging revealed a midthoracic intramedullary ring-like lesion that proved to be an abscess. Corticosteroids, gentamicin, and ciprofloxacin were given. The abscess resolved after three months. CONCLUSIONS Classically, treatment of intramedullary abscesses involves surgical drainage of the abscess cavity and administration of appropriate antibiotics, although medical therapy alone may be appropriate in some cases. If the diagnosis is unclear or patients do not respond to medical management, surgical decompression should be performed.
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Affiliation(s)
- Ali Akhaddar
- Department of Neurosurgery, Mohammed V Military Teaching Hospital, Rabat, Morocco.
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Higuchi K, Ishihara H, Okuda S, Kanda F. A 51-year-old man with intramedullary spinal cord abscess having a patent foramen ovale. BMJ Case Rep 2011; 2011:bcr.11.2010.3512. [PMID: 22696715 DOI: 10.1136/bcr.11.2010.3512] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The authors report a case of a 51-year-old man with intramedullary spinal cord abscess (ISCA) having a patent foramen ovale (PFO). He developed fever and tetraplegia after a recent dental treatment. MRI showed ISCA with longitudinal swelling from the upper cervical to the lumbar spinal cord. Cerebrospinal fluid (CSF) analysis indicated bacterial meningitis, and the culture of CSF revealed Streptococcus viridans. Transoesophageal echocardiography revealed the existence of a PFO. We suspected another possibility other than systemic bacteraemia, that paradoxical bacteric embolisation through PFO after the dental treatment caused ISCA. While several reports of brain abscess with PFO are available, this is the first report of ISCA with PFO.
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Affiliation(s)
- Kanako Higuchi
- Department of Neurology, Hyogo Prefectural Amagasaki Hospital, Amagasaki, Japan.
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Iwasaki M, Yano S, Aoyama T, Hida K, Iwasaki Y. Acute onset intramedullary spinal cord abscess with spinal artery occlusion: a case report and review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 20 Suppl 2:S294-301. [PMID: 21308472 DOI: 10.1007/s00586-011-1703-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 11/30/2010] [Accepted: 01/23/2011] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- Motoyuki Iwasaki
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo 060-8638, Japan.
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KURITA N, SAKURAI Y, TANIGUCHI M, TERAO T, TAKAHASHI H, MANNEN T. Intramedullary Spinal Cord Abscess Treated With Antibiotic Therapy -Case Report and Review-. Neurol Med Chir (Tokyo) 2009; 49:262-8. [DOI: 10.2176/nmc.49.262] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Makoto TANIGUCHI
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital
| | - Toru TERAO
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital
| | - Hiroshi TAKAHASHI
- Department of Neurosurgery, Tokyo Metropolitan Neurological Hospital
| | - Toru MANNEN
- Department of Neurology, Mitsui Memorial Hospital
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Abstract
Regardless of the compartment involved, imaging of spinal infections and other spinal inflammatory diseases must be performed by magnetic resonance imaging (MRI). This allows early detection of changes in disk space or vertebral bodies. Associated paraspinal and epidural masses are depicted. However, in spinal cord inflammation MRI has a very limited specificity and cannot usually differentiate between the wide array of possible causes of intramedullary lesions. This article covers a spectrum of inflammatory lesions of the spinal cord.
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Affiliation(s)
- I Grunwald
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, 66421, Homburg/Saar, Deutschland.
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Seizeur R, Condette-Auliac S, Goutagny S, Pencalet P, Gaillard S. [Chronic intramedullary abscess (Streptococcus sanguis). A case report and review of the literature]. Neurochirurgie 2007; 52:542-6. [PMID: 17203904 DOI: 10.1016/s0028-3770(06)71364-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Chronic intramedullary spinal cord abscesses are very rare. We present here a new case of this pathology, revealed by a progressive spinal cord compression. This case is particular because of the long follow up before surgery (two years). CASE REPORT This 69-year-old patient presented a gradually progressive paraparesis and sensory loss associated with leg pain. The past medical history was dominated by a epidermoid cancer of the tongue. MRI showed an intramedullary mass at T10. On the T1-weighted sequences, the lesion was isointense with the spinal cord, Gadolinium infusion showed homogeneous enhancement of the lesion. T2-weighted sequences showed decreased signal within the lesion and an increased signal peripherally (edema). Corticosteroid infusions relieved the symptoms so the patient declined surgery. Two episodes of regressive paraplegia were treated by the same infusions. The patient accepted surgery after a third episode. RESULTS The intervention was performed two years after the first signs and revealed a hard white mass attached to the spinal cord. Pathologic examination showed infectious inflammation. Bacteriological cultures found a Streptococcus sanguis. Two years later the patient could walk; a minimal deficit persists. CONCLUSION First, the diagnosis was evoked but not retained because of the long course. The corticosteroid infusions gave relief and did not increase the deficit. The MRI findings remained unchanged. Intramedullary spinal cord abscesses are very rare. This pathology must be recognized because without treatment morbidity is high with a potentially fatal outcome.
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Affiliation(s)
- R Seizeur
- Service de Neurochirurgie, Service de Neuroradiologie, Hopital de la Cavale Blanche, CHU de Brest, 29609 Brest Cedex.
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