Intramedullary Abscess by<i>Staphylococcus aureus</i>Presenting as Cauda Equina Syndrome to the Emergency Department

Damaskos, Dimitrios; Jumeau, Helene; Lens, F; Lechien, Philippe

doi:10.1155/2016/9546827

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…Mycobacterium tuberculosis is one of the primary causes of intramedullary abscesses in the developing world, with numerous cases having been reported [25]. Outside of the developing world, gram-positive cocci, especially those native to oral or skin flora (as were the cases here), are common causes of intramedullary abscesses [11,14,15,[26][27][28][29][30][31]. Opportunistic pathogens such as Fusarium spp.…”

Section: Discussionmentioning

confidence: 70%

“…Clinically, intramedullary abscesses can present with acute neurological deficits, mimicking an episode of transverse myelitis [35]. More commonly, intramedullary abscesses have a presentation characterized by progressive dorsal pain followed by neurological deficits as was seen in our patients [14,29,36,37]. On occasion, the clinical presentation can be more insidious, mimicking a spinal tumor or other conditions capable of inducing chronic myelopathy [38].…”

Section: Discussionmentioning

confidence: 89%

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Spontaneous intramedullary abscesses caused by Streptococcus anginosus: two case reports and review of the literature

et al. 2022

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Background Intramedullary abscesses are rare infections of the spinal cord. Intramedullary abscesses often have a complex presentation, making a high index of suspicion essential for prompt diagnosis and management. Case presentation We present two cases of intramedullary abscesses referred to and ultimately managed at our institution. Delayed diagnosis occurred in both instances due to the rarity of intramedullary abscesses and their propensity to mimic other pathologies. For both patients, prompt surgical management and the rapid institution of broad-spectrum antibiotics were critical in preventing further neurological decline. Conclusions Although rare, it is critical to consider intramedullary abscesses on the differential for any MRI lesions that are hyperintense on T2 and peripherally enhancing on T1 post-contrast sequences, as even short delays in treatment can lead to severe neurological damage.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 89%

Spontaneous intramedullary abscesses caused by Streptococcus anginosus: two case reports and review of the literature

et al. 2022

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“…Case [ 29 ] had a cervical spinal stenosis, extrinsically compressing the spinal cord. Twenty-two cases (31.4%) had extraspinal hematogenous spreads: urinary tract infection [ 6 , 21 , 27 ], pyelonephritis [ 19 ], bronchopneumonia [ 52 ], bronchiectasis [ 53 ], tuberculosis and SLE [ 26 , 39 ], brucellosis (32), oral infections and dental procedures [ 54 , 55 ], chronic kidney diseases [ 17 ], infective endocarditis [ 22 , 23 , 30 , 51 ], diabetes mellitus with systemic effects [ 21 , 22 , 42 , 45 ], disseminated coccidioidomycosis [ 28 ], histoplasmosis [ 56 ], and neurotuberculosis [ 57 ]. Three patients (4.2%) had apparent sepsis originating from either E. coli [ 19 ], S. aureus [ 48 ], or Gram-negative bacilli [ 27 ].…”

Section: Resultsmentioning

confidence: 99%

“…Anaerobes are uncommon, but many types of microorganisms have often been found in spinal abscesses in patients with ISCA [ 79 ]. Common causes of intramedullary abscesses include Gram-positive cocci, especially those native to oral or skin flora [ 13 , 14 , 20 , 27 , 30 , 37 , 56 , 64 , 84 ]. Implications for the selection of an empirical antimicrobial regimen in this population have arisen because opportunistic pathogens such as Fusarium spp.…”

Section: Discussionmentioning

confidence: 99%

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

Jabbar

Szmyd

Jankowski

et al. 2022

JCM

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Intramedullary spinal cord abscess (ISCA) is a rare clinical pathology of the central nervous system that usually accompanies other underlying comorbidities. Traditionally it has been associated with significant mortality and neurological morbidities because it is often difficult to diagnose promptly, owing to its nonspecific clinical and neuroimaging features. The mortality rate and the outcome of these infections have been improved by the introduction into clinical practice of antibiotics, advanced neuroimaging modalities, and immediate surgery. We report the case of a 65-year-old male patient who presented with a progressive spastic gait and lumbar pain, predominantly in the left leg. An MRI image revealed an expansile intramedullary cystic mass in the thoracic spinal cord, which was initially diagnosed as a spinal tumor. He underwent laminectomy and myelotomy, and eventually the pus was drained from the abscess. The follow-up MRI showed improvement, but the patient’s paraplegia persisted. In light of his persistent hypoesthesia and paraplegic gait with developing neuropathic pain, he was readmitted, and an MRI of his lumbar spine revealed multilevel degenerative disease and tethered spinal cord syndrome with compression of the medulla at the L2–L3 level. The patient underwent central flavectomy with bilateral foraminotomy at the L2–L3 level, and the medulla was decompressed. Postoperatively, his neurological symptoms were significantly improved, and he was discharged from hospital on the third day after admission. In support of our case, we systematically reviewed the recent literature and analyzed cases published between 1949 and May 2022, including clinical features, mechanisms of infection, predisposing factors, radiological investigations, microbial etiologies, therapies and their duration, follow-ups, and outcomes. Initial clinical presentation can be misleading, and the diagnosis can be challenging, because this condition is rare and coexists with other spinal diseases. Hence, a high index of suspicion for making an accurate diagnosis and timely intervention is required to preclude mortality and unfavorable outcomes. Our case is a clear example thereof. Long-term follow-up is also essential to monitor for abscess recurrences.

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Spinal Cord Abscesses

Akhaddar

2017

Atlas of Infections in Neurosurgery and Spinal Surgery

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Intramedullary Abscess byStaphylococcus aureusPresenting as Cauda Equina Syndrome to the Emergency Department

Cited by 4 publications

References 7 publications

Spontaneous intramedullary abscesses caused by Streptococcus anginosus: two case reports and review of the literature

Spontaneous intramedullary abscesses caused by Streptococcus anginosus: two case reports and review of the literature

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

Spinal Cord Abscesses

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