March 18, 2013
A 25-year-old woman with back pain and fever presents with bilateral lower extremity paresthesia and weakness.
Intramedullary Spinal Cord Abscess
- Intramedullary cord abscesses are uncommon.
- Etiology: the most common organisms are Staphylococcus and Streptococcus species, followed by gram-negative organisms and mixed flora. In most of the cases, the routes of infection are idiopathic/cryptogenic.
- Clinical presentation: symptoms of infection and neurological findings, related to the level of spinal cord involvement. Most common location: thoracic spinal cord.
- Key Diagnostic Features: MRI with contrast administration: Ring-enhancing mass within the spinal cord, with appropriate clinical history of inflammation/infection
- DDx: Intramedullary tumors, acute transverse myelitis, MS, cord infarction
- Rx: antibiotics; surgical debridement indicated if neurologic symptoms progress during medical therapy
