Management of intramedullary spinal cord abscess: experience with four cases, pathophysiology and outcomes

Abstract

Intramedullary spinal cord abscess (ISCA) in children is extremely a rare infection of the central nervous system (CNS); and probably a devastating neurological condition. Clinical awareness of patients at risk is crucial for early diagnosis and intervention; as this entity is one of the treatable conditions of paraparesis. Association with congenital neuro-ectodermal abnormality in children is frequent. This pathology highlights the importance of complete neurological checks of infants as a part of their routine physical examination and early management of patients with congenital dermal sinus, prophylactic surgical resection of such a congenital anomaly is recommended by most authors to prevent serious infections of the CNS. However, once the abscess is established; immediate surgical drainage along side adequate antibiotics should be instituted. This may guarantee improving neurological outcome. In this communication, the authors present their experience with four cases of ISCA in children treated successfully with surgical drainage, intravenous antibiotics and neuro rehabilitation between 2001 and 2006 and discuss their results. We concluded that early diagnosis and treatment is essential; before a devastating mechanico-vascular insult of the spinal cord is established from rapid formation of the abscess and a swift expansion of the spinal cord within the limited intraspinal space.

Intramedullary abscess complicating congenital dermal sinus tract in an infant: A rare occurrence

“…An epidermoid tumour associated with the CDS noticed intraoperatively was also excised (Figure 4). Congenital dermal sinus (CDS) is an uncommon form of spinal dysraphism, which if ignored can cause meningitis or infect the spaces around the spinal cord or lead to ISCA as has happened to our patient 1,2 . In all probability the clinicians consulted initially confused CDS with coccygeal pit, a benign and distinctly different entity occurring in approximately 4% of the general population 3 .…”

“…Our patient had an epidermoid tumour associated with the tract which was detected only during surgery (Figure 4). It is documented in the literature that the associated tumours may be revealed by MRI or rarely only at the time of operation 2,3 .…”

“…Our patient also had the same but whether CDS with midline skin lesions have increased chance of developing ISCA is not clear 1,4,5 . Intramedullary spinal cord abscess may present at any age but children under the age of five are more likely to be affected 2,5 . Mean age of presentation has decreased over the years 1,2 .…”

“…Intramedullary spinal cord abscess may present at any age but children under the age of five are more likely to be affected 2,5 . Mean age of presentation has decreased over the years 1,2 . Patients with infections from contiguous spread are usually younger than those with infections secondary to other mechanisms 1,2 .…”

“…Mean age of presentation has decreased over the years 1,2 . Patients with infections from contiguous spread are usually younger than those with infections secondary to other mechanisms 1,2 . Once infection develops in the spinal cord, it spreads longitudinally along the fibre tracts of the cord.…”