Intramedullary abscess of the cervical spinal cord in an otherwise healthy man

An intramedullary spinal cord abscess is a rare, albeit widely publicized entity. Classically, patients have an acute onset of symptoms with fevers and leukocytosis supporting the diagnosis. We present a case of intramedullary spinal cord without classic history or imaging characteristics in which the diagnosis was made with diffusion weighted magnetic resonance imaging (MRI).

A 57-year-old physician presented with severe neck and shoulder pain, which progressed over several days to right-sided hemiparesis with dysesthesias. There was no history of fevers, rigors, or illness. A contrast enhanced MRI of the cervical spine revealed an intramedullary lesion centered around C6-T1 that showed peripheral enhancement with gadolinium and edema extending rostrally and caudally. He was then transferred to our institution where the novel application of diffusion weighted MRI of the spinal cord was performed, suggesting an abscess. He then underwent focal laminectomies and biopsy of this lesion with drainage of the necrotic cavity. Intraoperative Gram stain revealed gram-positive cocci, and cultures were sent to the laboratory. After draining the purulent material and completing a course of tailored antibiotics, the patient showed improvement of his neurologic deficit.

The use of diffusion weighted imaging in the spine is a novel application of technology that provided an accurate preoperative diagnosis and allowed us to tailor our surgical approach and provide a rapid focal decompression.