[Intramedullary abscess of the spinal cord--a rare pathology. Case report, therapeutic regimen and review of the literature].
Although the presence of an intramedullary abscess of the spinal cord is extremely rare, it is most important to be aware of its existence in the differential diagnosis of neurological diseases. Existing neurological deficits with progressive symptoms of paraplegia should always be regarded as suspect and a differential diagnosis of an intramedullary abscess of the spinal cord should then be included in the therapeutical regimen. A correct diagnosis using MR-tomography followed by an early surgical treatment strategy are essential for the affected patients, simply because an early diagnosis and an immediate operative intervention represent decisive prognostic factors independent from the cause of infection. Surgical intervention must include a decompressive laminectomy, a myelotomy, and also a secure intraoperative abscess drainage. In this analysis two patients will be reported on, both of whom were already showing symptoms of paraplegia at the time they were admitted to hospital. In both cases MR-tomographically an intramedullary nodulary lesion of the spinal cord could be detected. However, due to a complete lack of any acute symptoms of inflammatory reaction in one patient, an intramedullary abscess was not actually diagnosed before surgical treatment was performed. These two cases, together with existing scientific literature, aim to present an overview of the pathogenesis, the clinical symptomatology, the treatment strategy, and the expected therapeutical outcome of an intramedullary abscess formation. It will be shown that by treating this disease as early as possible using adequate therapeutic interventions a functional improvement of the resulting neurological symptoms can be expected.
Esenwein
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SA
Berufsgenossenschaftliche Kliniken Bergmannsheil, Universitätsklinik der Ruhr-Universität Bochum, Chirurgische Klinik mit Poliklinik, Bochum, Germany. Stefan.A.Esenwein@ruhr-uni-bochum.de
Horch
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Meindl
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Muhr
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Bötel Dagger
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U
D000038:Abscess / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D019299:Decompression, Surgical; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology* / Q000601:surgery; D019635:Neurosurgical Procedures; D011859:Radiography; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D014399:Tuberculosis, Spinal / Q000473:pathology / Q000601:surgery