Spinal intramedullary abscess with an epidermoid secondary to a dermal sinus.
Congenital dermal sinuses are relatively uncommon, and result from abnormal neurulation. A lack of awareness about this problem causes these patients to manifest significant mortality and morbidity. Spinal intramedullary abscesses are rare and potentially devastating lesions. Intraspinal epidermoids are also unusual lesions. We report on a boy, aged 1 year and 5 months, who had a lower-back hairy hemangioma at birth without further evaluation, and dermal sinus tract without surgical intervention at age 7 months. He also manifested rapidly progressive paraplegia with urine and stool retention, and was found to have a spinal intramedullary abscess with an epidermoid as the result of a dermal sinus. This patient illustrates the importance of the recognition and evaluation of skin markers, and of an awareness and complete neurological assessment of all patients with a congenital dermal sinus, because of the potential for intradural extension and a frequent association with other dysraphic abnormalities. Prophylactic surgery is indicated to prevent dangerous and recurrent infections of the central nervous system.
Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan. hongfh@ms14.hinet.net
Po-Cheng
PC
Hung
Huei-Shyong
HS
Wang
Chieh-Tsai
CT
Wu
Tai-Ngar
TN
Lui
Alex M-C
AM
Wong
D000038:Abscess / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D010264:Paraplegia / Q000209:etiology / Q000473:pathology; D016136:Spina Bifida Occulta / Q000150:complications* / Q000473:pathology; D013118:Spinal Cord Diseases / Q000209:etiology* / Q000473:pathology