Infected intraparenchymal dermoids: an underestimated entity

Area of Science:

• Neurology
• Infectious Diseases
• Dermatology

Background:

• Dermal sinuses are congenital abnormalities that can lead to infections.
• Infections typically manifest as superficial abscesses but can rarely extend to the central nervous system.

Purpose of the Study:

• To present the clinicoradiological findings of intramedullary abscesses secondary to dermal sinuses.
• To emphasize the role of dermal sinuses as a pathway for central nervous system infections.
• To review the management and outcomes of these rare cases.

Main Methods:

• Retrospective analysis of 19 patients with intramedullary abscesses associated with dermal sinuses.
• Review of clinical presentation, radiological imaging, microbiological data, and treatment outcomes.
• Surgical exploration, pus drainage, abscess wall excision, and prolonged antibiotic therapy.

Main Results:

• Dermal sinuses can serve as a route for infections leading to intramedullary abscesses.
• Methicillin-sensitive Staphylococcus aureus was the most common pathogen.
• Outcomes varied: 7 patients recovered fully, 7 partially, and 5 showed no improvement. Motor function improved partially, but bladder function recovery was poor.

Conclusions:

• Intramedullary abscesses secondary to dermal sinuses are rare but severe neurological complications.
• Early surgical intervention and antibiotics are crucial for management.
• Prognosis is guarded, with significant potential for long-term neurological deficits, particularly in bladder control.