Reversible Holocord Edema Associated with Intramedullary Spinal Abscess Secondary to an Infected Dermoid Cyst

Tsurubuchi, Takao; Matsumura, Akira; Nakai, Kei; Fujita, Keishi; Enomoto, Takao; Iwasaki, Naoya; Nose, Tadao

doi:10.1159/000066306

Cited by 20 publications

(17 citation statements)

References 7 publications

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“…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. The patients with chronic presentation (>6 weeks) behave similar to that of an expanding intramedullary neoplasm [5]. As our patient had 12-week duration of symptoms, she had chronic type of presentation.…”

Section: Discussionsupporting

confidence: 56%

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

Mohindra

Sodhi²,

Aggarwal³

2011

Childs Nerv Syst

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Section: Discussionsupporting

confidence: 56%

“…Intense perilesional edema within the cord substance is noted as hyperintense signals on T2 scans. The rapid spread of cord edema, rather than the abscess itself, is the main culprit of causing fulminant neurological deterioration among these patients [3,5].…”

Section: Discussionmentioning

confidence: 99%

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

Mohindra

Sodhi²,

Aggarwal³

2011

Childs Nerv Syst

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“…1,5,10,18 The aims of surgery are to obtain a diagnosis, ascertain the causative organism if not already determined through culture of sinus wound discharge, drain the abscess, excise the wall of the dermoid cyst as much as safely possible, and remove the source of infection (dermal sinus). We prefer to perform surgery early in children with a diagnosis of dermal sinus with or without an intraspinal dermoid cyst.…”

Section: Surgery and Outcomementioning

confidence: 99%

Rapid-onset paraparesis and quadriparesis in patients with intramedullary spinal dermoid cysts: report of 10 cases

Girishan

Rajshekhar

2016

Journal of Neurosurgery: Pediatrics

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OBJECT Intramedullary dermoid cysts are rare tumors of the spinal cord. Presentation with rapid onset of paraparesis or quadriparesis (onset within 2 weeks) is rarer still. The authors present their experience in the management and outcome of patients with such a presentation. METHODS Patient records between 2000 and 2014 were retrospectively reviewed to identify those with intraspinal dermoid cysts who presented with rapid-onset paraparesis or quadriparesis. Their clinical, radiological, operative, and follow-up data were analyzed. RESULTS Of a total of 50 patients with intraspinal dermoid cysts managed during the study period, 10 (20%) presented with rapid-onset paraparesis or quadriparesis; 9 patients ranged in age from 8 months to 2 years, and 1 patient was 25 years old. A dermal sinus was seen in the lumbar region of 4 patients, the sacral region of 3, and the thoracic region of 1, and in 1 patient no sinus was found. All except 1 patient presented with rapid-onset paraparesis secondary to infection of the intramedullary dermoid cyst. One patient presented with rupture of a dermoid cyst with extension into the central canal up to the medulla. Early surgery was done soon after presentation in all except 2 patients. Among the 9 patients who underwent surgery (1 patient did not undergo surgery), total excision of the intramedullary dermoid cyst was done in 3 patients, near-total excision in 4 patients, and partial excision in 2 patients. Of the 9 patients who underwent surgery, 8 showed significant improvement in their neurological status, and 1 patient remained stable. The 1 patient who did not undergo surgery died as a result of an uncontrolled infection after being discharged to a local facility for management of wound infection. CONCLUSIONS Early recognition of a dermal sinus and the associated intraspinal dermoid cyst and timely surgical intervention can eliminate the chances of acute deterioration of neurological function. Even after an acute onset of paraparesis or quadriparesis, appropriate antibiotic therapy and prompt surgery can provide reasonably good outcomes in these patients.

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“…Plastered intradural neural tissues, including cauda equina, along with arachnoidal membranes warrant meticulous intraoperative irrigation. 9 Needle aspiration followed by myelotomy and pus drainage, without radical tumor wall excision, minimizes the neurological deficits. With the abscess cavity open, draining out pus seems adequate, and vigorous abscess wall scrapping is not required.…”

Section: Surgerymentioning

confidence: 99%

“…Central cord edema as noted on T2-weighted images does not correlate with clinical outcome and tends to subside with antibiotics administration. 9 Pediatricians if made aware of dermal sinuses can take a lead in radiological evaluation of such patients, preventing infective complications of central nervous system, by referring the children for prophylactic intervention. 1…”

Section: Outcomementioning

confidence: 99%

Infected Intraparenchymal Dermoids: An Underestimated Entity

et al. 2008

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Infection secondary to a dermal sinus most commonly occurs in the form of cutaneous, epidural, or subdural abscesses. Rarely, it can result in an intramedullary abscess as a result of a dermal sinus. This study presents a clinicoradiological profile of 19 cases harboring abscesses within the dermoids and highlights the importance of dermal sinus acting as a pathway for infections to enter the nervous system. Emergent exploration, pus drainage, and minimal abscess wall excision along with prolonged antibiotic administration remained the management of choice in all cases. Methicillin-sensitive Staphylococcus aureus was the commonest offending organism. In all, 7 patients recovered to normal neurological status, 5 showed no improvement, and 7 improved partially. Improvement in motor power was noted, albeit partially, but bladder functions failed to recover even at long-term follow-up. Even when such infective complications of dermal sinuses are rare, these are potentially serious and disabling.

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Reversible Holocord Edema Associated with Intramedullary Spinal Abscess Secondary to an Infected Dermoid Cyst

Cited by 20 publications

References 7 publications

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

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

Rapid-onset paraparesis and quadriparesis in patients with intramedullary spinal dermoid cysts: report of 10 cases

Infected Intraparenchymal Dermoids: An Underestimated Entity

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