Rapidly Progressing Intramedullary Spinal Cord Abscess: A Case Report

Abstract

Intramedullary spinal cord abscess is a rare and severe infectious disease characterized by devastating neurological deficits. We report a case of cervical intramedullary spinal cord abscess in a 74-year-old diabetic male with a 3-day history of neck pain and weakness in the right lower extremity. Magnetic resonance imaging revealed a ring-shaped contrast lesion in C3-C6 of the cervical spinal cord with extensive edema. Further, 1 day after admission, he became comatose (Glasgow Coma Scale E1VtM1), and a computed tomography head scan revealed hydrocephalus. Despite emergency ventricular drainage, the patient's level of consciousness remained unchanged. Magnetic resonance imaging performed 1 day after surgery revealed bilateral intracranial extension of the abscess into the thalamus and caudate nucleus. The patient died 19 days after admission. Our report is the first case of extensive brain abscess development over a short period. Based on our experience, prompt administration of antibiotics and emergency abscess drainage of the cervical cord (and ventricular drainage, if necessary) are recommended in cases of neurological deterioration in patients with cervical intramedullary spinal cord abscess.

Keywords: cervical; infectious disease; intramedullary spinal cord abscess.

Fig. 1

Contrast-enhanced (a and c) and T2-weighted (b and d) MR images acquired in the sagittal plane. a, b: Ring-shaped contrast lesions at C3-C6 with extensive edema. c: MR images after starting antibiotic treatment. A change in the shape of the contrasting lesion is observed. d: Widening of the upper and lower edematous regions. MR: magnetic resonance

Fig. 2

Imaging test findings. a: Head CT scan at the time of a sudden loss of consciousness revealing acute hydrocephalus. b: Low-density areas of the right cerebellar hemisphere. c: No vascular occlusive findings on 3D-CTA. d: CT performed 1 day after ventricular drainage, revealing symmetrical low-density areas in the caudate nucleus and thalamus. e, f: Diffusion-weighted MR images leading to abscess diagnosis. g: T1-weighted contrast-enhanced MR. CT: computed tomography. 3D-CTA: 3-dimensional computed tomography angiography. MR: magnetic resonance

Fig. 3

Macrograph of the spinal cord (a) and photomicrographs of hematoxylin and eosin staining (b, c, and d). Magnification: ×100 (b) and ×400 (c, d). a: Yellowish intramedullary abscesses throughout the spinal cord. b: Reactive gliosis surrounding the abscess (*). c, d: Inflammatory cell infiltration around the anterior spinal artery (arrow) and vasa corona (arrowhead).