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Diagnosis and Surgical Treatment of Human Brucellar Spondylodiscitis
Published on: May 23, 2021
[Paraplegia associated with intramedullary spinal cord and epidural abcesses, meningitis and spondylodiscitis
J-P Ferroir1, F-X Lescure, C Giannesini
1Service de neurologie, hôpital Tenon, 4 rue de la Chine, Paris cedex 20, France. jean-pierre.ferroir@tnn.aphp.fr
Introduction:
Intramedullary spinal cord abscesses are rare, frequently associated with meningitis, sometimes with epidural abscesses. They are frequently responsible for paraplegia. Staphylococcus aureus is the predominant organism. MRI shows an intramedullary collection giving a low-intensity signal on T1-weighted images with peripheral contrast uptake on enhanced TI-weighted studies and a high-intensity signal on T2-weighted images with generally extended adjacent medullary edema. They may be multiple.
Case Report:
We report the case of a man who presented meningitis with intramedullary and epidural abscesses. The number of the lesions did not allow chirurgical drainage. The paraplegia did not resolve despite appropriate antibiotic therapy.
Conclusion:
Appropriate antibiotic therapy and early surgical drainage, if feasible, are key factors for better outcome and prognosis.
Insights
Spinal cord abscesses, often caused by Staphylococcus aureus, can lead to paraplegia. Early surgical drainage and antibiotics are crucial for better outcomes in these rare infections.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Intramedullary spinal cord abscesses are rare neurological infections.
- Often associated with meningitis and epidural abscesses, leading to paraplegia.
- Staphylococcus aureus is the most common causative organism.
Observation:
- A case of meningitis with coexisting intramedullary and epidural abscesses is presented.
- Multiple lesions precluded surgical drainage.
- Paraplegia persisted despite antibiotic treatment.
Findings:
- MRI reveals intramedullary collections with characteristic signal intensities on T1 and T2-weighted images.
- Abscesses show peripheral contrast enhancement on T1-weighted sequences.
- Adjacent medullary edema is typically extensive.
Implications:
- Early surgical intervention, when feasible, is critical for managing spinal cord abscesses.
- Prompt and appropriate antibiotic therapy is essential for favorable prognosis.
- Multifocal abscesses present significant management challenges.
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