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What Is Currently Known about Intramedullary Spinal Cord Abscess among Children? A Concise Review
Bartosz Szmyd1,2, Redwan Jabbar1, Weronika Lusa1
1Department of Neurosurgery, Spine and Peripheral Nerves Surgery, Medical University of Lodz, 90-549 Lodz, Poland.
Insights
Intramedullary spinal cord abscesses (ISCA) are rare in children, often presenting with atypical symptoms. Prompt diagnosis and treatment, including antibiotics and surgery, lead to good outcomes in most pediatric cases.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Neurosurgery
Background:
- Intramedullary spinal cord abscesses (ISCA) are uncommon conditions in pediatric patients.
- Symptoms can be subtle and uncharacteristic in younger children, complicating early diagnosis.
- Treatment typically involves antibiotics and surgical intervention.
Purpose of the Study:
- To review and analyze published pediatric cases of ISCA.
- To identify common symptoms, predisposing factors, and pathogens.
- To evaluate treatment outcomes and prognosis in children.
Main Methods:
- Systematic review of published literature on pediatric ISCA cases.
- Analysis of patient demographics, clinical presentation, diagnostic findings, and treatment strategies.
- Evaluation of neurological recovery and long-term outcomes.
Main Results:
- Most pediatric ISCA cases occurred in children under 6 years old.
- Common symptoms included motor deficits (89%), signs of infection (86%), and sensory deficits (39%).
- Predisposing factors included dermal sinuses and congenital cysts; common pathogens were *Staphylococcus aureus* and *Mycobacterium tuberculosis*.
Conclusions:
- Pediatric ISCA, while rare, can be effectively treated with antibiotics and surgery.
- Early diagnosis and intervention are crucial for favorable neurological outcomes.
- The majority of pediatric patients experience significant neurological recovery.
Abstract:
Intramedullary spinal cord abscesses (ISCA) are rare. Typical symptoms include signs of infection and neurological deficits. Symptoms among (younger) children can be highly uncharacteristic. Therefore, prompt and proper diagnoses may be difficult. Typical therapeutic options include antibiotics and neurosurgical exploration and drainage. In this review, we analyze published cases of ISCA among children. Most pediatric cases were found to be under the age of 6 years. The typical symptoms included motor deficits in 89.06%, infection signs in 85.94%, and sensory deficits in 39.06%. Urinary dysfunction was observed in 43.75%, and bowel dysfunction in 17.19%. The predisposing factors included dermal sinuses, (epi)dermoid cysts, prior infection, iatrogenic disorder, and trauma. The most common pathogens were: Staphylococcus aureus, Mycobacterium tuberculosis, Escherichia coli, and Proteus mirabilis. The pediatric population has good outcomes as 45.93% of patients had complete neurological recovery and only 26.56% had residual neurological deficits. Fifteen (23.44%) had persistent neurological deficits. Only one (1.56%) patient died with an ISCA. In two (3.13%) cases, there were no details about follow-up examinations.
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