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Management of intramedullary spinal cord abscess: experience with four cases, pathophysiology and outcomes
Moh'd Al Barbarawi1, Wadah Khriesat, Suhair Qudsieh
1Division of Neurosurgery, Department of Neuroscience, Faculty of Medicine, King Abdullah University Hospital, Jordan University of Science and Technology, Irbid, Jordan. dr_barbarawi@yahoo.com
Insights
Intramedullary spinal cord abscess (ISCA) is a rare but treatable CNS infection in children. Early diagnosis and intervention, including surgical drainage and antibiotics, are crucial for preventing devastating neurological damage.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Intramedullary spinal cord abscess (ISCA) is a rare and potentially devastating central nervous system (CNS) infection in children.
- Early diagnosis and intervention are critical as ISCA is a treatable cause of paraparesis.
Observation:
- Congenital neuro-ectodermal abnormalities are frequently associated with ISCA in pediatric patients.
- Routine neurological examinations in infants and early management of conditions like congenital dermal sinus are vital.
- Prophylactic surgical resection of congenital anomalies is often recommended to prevent CNS infections.
Findings:
- Successful treatment of four pediatric ISCA cases involved surgical drainage, intravenous antibiotics, and neurorehabilitation.
- Prompt surgical drainage and adequate antibiotic therapy are essential once an abscess is established.
- Early diagnosis and treatment are key to improving neurological outcomes and preventing mechanico-vascular insult.
Implications:
- Highlights the importance of clinical awareness and prompt management of ISCA in at-risk children.
- Emphasizes the need for comprehensive neurological assessments in infants, especially those with congenital anomalies.
- Successful outcomes depend on timely intervention before irreversible spinal cord damage occurs.
Abstract:
Intramedullary spinal cord abscess (ISCA) in children is extremely a rare infection of the central nervous system (CNS); and probably a devastating neurological condition. Clinical awareness of patients at risk is crucial for early diagnosis and intervention; as this entity is one of the treatable conditions of paraparesis. Association with congenital neuro-ectodermal abnormality in children is frequent. This pathology highlights the importance of complete neurological checks of infants as a part of their routine physical examination and early management of patients with congenital dermal sinus, prophylactic surgical resection of such a congenital anomaly is recommended by most authors to prevent serious infections of the CNS. However, once the abscess is established; immediate surgical drainage along side adequate antibiotics should be instituted. This may guarantee improving neurological outcome. In this communication, the authors present their experience with four cases of ISCA in children treated successfully with surgical drainage, intravenous antibiotics and neuro rehabilitation between 2001 and 2006 and discuss their results. We concluded that early diagnosis and treatment is essential; before a devastating mechanico-vascular insult of the spinal cord is established from rapid formation of the abscess and a swift expansion of the spinal cord within the limited intraspinal space.
