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Intramedullary cervical abscess mimicking a spinal cord tumor in a 10-year-old girl: a case-based review

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Abstract

Background

Intramedullary spinal cord abscesses (ISCA) are a rare pathological entity with very few cases reported in the world and may be confused with an intramedullary tumor. Cervical location is the least frequently affected, except for cryptogenic spread, mostly seen in adult patients. Meticulous study of contrast-enhanced MRI pictures has a key role in the diagnosis.

Method and results

We present a case of a spontaneous cervical ISCA, mimicking a spinal cord tumor, in a pediatric patient with good outcome. A review of the literature shows that this is a life-threatening condition with high chances of rupture and subsequent meningitis.

Conclusions

We point out that if a solitary cervical spinal cord lesion is surrounded by significant medullar edema associated with fast onset of symptoms, fever, and elevation of WBC, the possibility of a spinal cord abscess should be considered prior to surgery.

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References

  1. Al Barbarawi M, Khriesat W, Qudsieh S, Qudsieh H, Loai AA (2009) Management of intramedullary spinal cord abscess: experience with four cases, pathophysiology and outcomes. Eur Spine J 18:710–717. https://doi.org/10.1007/s00586-009-0885-0

    Article  PubMed  PubMed Central  Google Scholar 

  2. Arbelaez A, Restrepo F, Castillo M (2014) Spinal infections: clinical and imaging features. Top Magn Reson Imaging 23:303–314. https://doi.org/10.1097/RMR.0000000000000032

    Article  PubMed  Google Scholar 

  3. Arnáiz-García ME, González-Santos JM, López-Rodriguez J, Dalmau-Sorli MJ, Bueno-Codoñer M, Arévalo-Abascal A (2015) Intramedullary cervical abscess in the setting of aortic valve endocarditis. Asian Cardiovasc Thorac Ann 23:64–66. https://doi.org/10.1177/0218492313495861

    Article  PubMed  Google Scholar 

  4. Arzt PK (1944) Abscess within the spinal cord: review of the literature and report of three cases. Arch Neurol Psychiatr 51:533–543. https://doi.org/10.1001/archneurpsyc.1944.02290300035004

    Article  Google Scholar 

  5. Baradaran N, Ahmadi H, Nejat F, Khashab M, Mahdavi A, Rahbarimanesh AA (2008) Recurrent meningitis caused by cervico-medullary abscess, a rare presentation. Childs Nerv Syst 24:767–771. https://doi.org/10.1007/s00381-008-0593-9

    Article  PubMed  Google Scholar 

  6. Bhanage A, Katkar A, Ghate P, Ratta B (2015) Intra-medullary tubercular abscess with spinal dysraphism: an unusual case. J Pediatr Neurosci 10:73–75. https://doi.org/10.4103/1817-1745.154361

    Article  PubMed  PubMed Central  Google Scholar 

  7. Bukhari EE, Alotibi FE (2013) Fatal streptococcus melleri meningitis complicating missed infected intramedullary dermoid cyst secondary to dermal sinus in a Saudi child. J Trop Pediatr 59:246–249. https://doi.org/10.1093/tropej/fms073

    Article  PubMed  Google Scholar 

  8. Chan CT, Gold WL (1998) Intramedullary abscess of the spinal cord in the antibiotic era: clinical features, microbial etiologies, trends in pathogenesis, and outcomes. Clin Infect Dis 27:619–626

    Article  CAS  Google Scholar 

  9. Da Silva PSL, De Souza Loduca RD (2013) Intramedullary spinal cord abscess as complication of lumbar puncture: a case-based update. Childs Nerv Syst 29:1061–1068. https://doi.org/10.1007/s00381-013-2093-9

    Article  PubMed  Google Scholar 

  10. Devi BI, Chandra S, Mongia S, Chandramouli BA, Sastry KVR, Shankar SSK (2002) Spinal intramedullary tuberculoma and abscess: a rare cause of paraparesis. Neurol India 50:494–496

    PubMed  Google Scholar 

  11. Dho YS, Kim SK, Wang KC, Phi JH (2015) Catastrophic intramedullary abscess caused by a missed congenital dermal sinus. J Korean Neurosurg Soc 57:225–228. https://doi.org/10.3340/jkns.2015.57.3.225

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Dörflinger-Hejlek E, Kirsch EC, Reiter H, Opravil M, Kaim AH (2010) Diffusion-weighted MR imaging of intramedullary spinal cord abscess. Am J Neuroradiol 31:1651–1652. https://doi.org/10.3174/ajnr.A1912

    Article  PubMed  Google Scholar 

  13. Fernández-Ruiz M, López-Medrano F, García-Montero M, Hornedo-Muguiro J, Aguado JM (2009) Intramedullary cervical spinal cord abscess by viridans group Streptococcus secondary to infective endocarditis and facilitated by previous local radiotherapy. Intern Med 48:61–64. https://doi.org/10.2169/internalmedicine.48.1548

    Article  PubMed  Google Scholar 

  14. Iwasaki M, Yano S, Aoyama T, Hida K, Iwasaki Y (2011) Acute onset intramedullary spinal cord abscess with spinal artery occlusion: a case report and review. Eur Spine J 20:S294–S301. https://doi.org/10.1007/s00586-011-1703-z

    Article  PubMed  Google Scholar 

  15. Kurita N, Sakurai Y, Taniguchi M, Terao T, Takahashi H, Mannen T (2009) Intramedullary spinal cord abscess treated with antibiotic therapy—case report and review. Neurol Med Chir 49:262–268. https://doi.org/10.2176/nmc.49.262

    Article  Google Scholar 

  16. Liu HW, Tsai MC (2012) Intra-medullary abscess of the spinal cord at the high cervical level. Formosan J Surg 45:194–197. https://doi.org/10.1016/j.fjs.2012.08.004

    Article  Google Scholar 

  17. Murphy KJ, Brunberg JA, Quint DJ, Kazanjian PH (1998) Spinal cord infection: myelitis and abscess formation. Am J Neuroradiol 19:341–348

    CAS  PubMed  Google Scholar 

  18. Roh JE, Lee SY, Cha SH, Cho BS, Jeon MH, Kang MH (2011) Sequential magnetic resonance imaging finding of intramedullary spinal cord abscess including diffusion weighted image: a case report. Korean J Radiol 12:241–246. https://doi.org/10.3348/kjr.2011.12.2.241

    Article  PubMed  PubMed Central  Google Scholar 

  19. Sinha P, Parekh T, Pal D (2013) Intramedullary abscess of the upper cervical spinal cord. Unusual presentation and dilemmas of management: case report. Clin Neurol Neurosurg 115:1845–1850. https://doi.org/10.1016/j.clineuro.2013.01.008

    Article  PubMed  Google Scholar 

  20. Vadivelu S, Desai SK, Illner A, Luerssen TG, Jea A (2014) Infected lumbar dermoid cyst mimicking intramedullary spinal cord tumor: observations and outcomes. J Pediatr Neurosci 9:21–26. https://doi.org/10.4103/1817-1745.131475

    Article  PubMed  PubMed Central  Google Scholar 

  21. Vajramani GV, Nagmoti MB, Patil CS (2005) Neurobrucellosis presenting as an intra-medullary spinal cord abscess. Ann Clin Microbiol Antimicrob 4:14. https://doi.org/10.1186/1476-0711-4-14

    Article  PubMed  PubMed Central  Google Scholar 

  22. Watts J, Box GA, Galvin A, Van Tonder F, Trost N, Sutherland T (2014) Magnetic resonance imaging of intramedullary spinal cord lesions: a pictorial review. J Med Imaging Radiat Oncol 58:569–581. https://doi.org/10.1111/1754-9485.12202

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Equipo de Neurocirugía Pediátrica, Servicio Especializado en Pediatría y Neonatología (SEPyN), Hospital Español, Buenos Aires, Argentina

    Exequiel Patricio Verdier, Omar Konsol & Santiago Portillo

  2. División de Neurocirugía Pediátrica, Hospital de Niños Dr. Ricardo Gutiérrez, Buenos Aires, Argentina

    Exequiel Patricio Verdier

  3. Servicio de Neurocirugía Pediátrica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

    Omar Konsol & Santiago Portillo

Authors
  1. Exequiel Patricio Verdier
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  2. Omar Konsol
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  3. Santiago Portillo
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Correspondence to Exequiel Patricio Verdier.

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Verdier, E.P., Konsol, O. & Portillo, S. Intramedullary cervical abscess mimicking a spinal cord tumor in a 10-year-old girl: a case-based review. Childs Nerv Syst 34, 2143–2147 (2018). https://doi.org/10.1007/s00381-018-3873-z

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  • DOI: https://doi.org/10.1007/s00381-018-3873-z

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