title: Acute onset intramedullary spinal cord abscess with spinal artery occlusion: a case report and review.
abstract: Intramedullary spinal cord abscess (ISCA) without meningitis is an extremely rare entity in the central nervous system, and it is often difficult to diagnose immediately, and no definitive imaging findings have been established. We experienced the case of a 61-year-old male who presented with a sudden onset back pain without fever following rapidly worsening paraparesis for 3 days, who subsequently become unable to walk. According to the initial MRI and 3D-CTA, the presumptive diagnosis was spinal infarction due to spinal artery embolism. However, his symptoms did not improve, despite the gradual changes in MRI following antiplatelet therapy. He underwent a biopsy in an attempt to prevent the lesion from progressing toward the upper spinal cord. The pathological examination revealed an intramedullary abscess, so we performed a midline myelotomy and drained the pus from the abscess. After surgery, MRI showed improvement, but the patient's paraplegia persisted. To the best of our knowledge, this is the first case report of spinal cord abscess with the confirmation of spinal artery occlusion on angiography, which could have been caused by a bacterial embolism. We herein discuss its possible etiology and also review recent reports on ISCA.
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo 060-8638, Japan. jzesso801@yahoo.co.jp
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Iwasaki
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Yano
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aoyama
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Hida
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Iwasaki
mesh_terms: D000038:Abscess / Q000150:complications* / Q000473:pathology / Q000601:surgery; D001157:Arterial Occlusive Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007796:Laminectomy; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013116:Spinal Cord / Q000098:blood supply*; D013118:Spinal Cord Diseases / Q000150:complications* / Q000473:pathology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome