Holocord intramedullary abscess: an unusual case with review of literature

Abstract

Study design: A rare case of a holocord intramedullary abscess with review of literature. Objectives: Summary of clinical presentation, radiology, microbiology, etiology and management of intramedullary spinal cord abscess. Abscess involving the entire spinal cord is extremely rare and awareness of such an event could avoid delay in evacuation of the absess. Methods: The incidence, clinical presentation, radiological investigations, treatment and etiology of intramedullary spinal cord abscess in 100 consecutive cases are discussed. Results: Intramedullary spinal cord abscesses are rare. Presently, only ®ve cases of holocord intramedullary abscess are described. In our analysis of 100 cases of intramedullary abscess, a male preponderance was found. The ®rst and the third decades were the most common age groups. Prognosis is poor if treatment is delayed. Contrast-enhanced MRI is the ideal investigation for diagnosis. Prompt surgical drainage of the abscess with appropriate antibiotic therapy is mandatory since the natural course of the disease has a very unfavourable outcome. Staphylococcus and Streptococcus were the most common causative organisms. Conclusion: Intramedullary spinal cord abscess along the entire length of spinal cord is rare. A thorough history with precise clinical localisation, a high index of suspicion, contrastenhanced MRI at appropriate level and prompt surgical drainage with appropriate antibiotic therapy are key to the eventual outcome and prognosis.

Management problems of intramedullary holocord abscess: an illustration in a pediatric case

“…The English literature describes only eight cases of holocord abscesses [1,2]. The abscess commonly involves the thoracic cord first and then extends longitudinally preferably along the fiber tracts [2].…”

“…The abscess commonly involves the thoracic cord first and then extends longitudinally preferably along the fiber tracts [2]. The sluggish blood flow in the dorsal cord along with watershed zone of vascularity makes it more prone for hematogenous bacteria to lodge within its substance.…”

Dermal sinus complicated by intramedullar abscess of spinal cord (case report)

“…Во избежание широкой ламинэкто-мии и последующих ортопедических нарушений [8,19] большинство авторов рекомендуют ограниченную миелотомию и дренирование разделенных гнойных полостей. Комплексное лечение, включающее раннее хирургическое вмешательство, антибактериальную терапию и раннюю реабилитацию, обеспечивает благоприятный исход [20][21][22][23][24].…”

Recurrent intradural spinal tuberculosis abscess in a child – follow-up magnetic resonance imaging

“…Immune-compromised patients are also affected by spinal TB infection in developed countries. A small number of cases with abscess of the spinal cord due to tuberculosis have been reported in the literature [1][2][3]. It may cause neurological symptoms as seen in spinal cord neoplasms.…”

“…Spinal cord TB abscess is a rare clinical entity; few cases have been reported in the literature [1][2][3]. The clinical presentation of spinal cord TB abscess is characterized by fever and back pain, and, according to the localization of the abscess in the spinal cord, shoulder, hip or extremity pain can occur.…”