Intramedullary Spinal Cord Abscess with Concomitant Spinal Degenerative Diseases: A Case Report and Systematic...

Area of Science:

• Neurology
• Neurosurgery
• Infectious Diseases

Background:

• Intramedullary spinal cord abscess (ISCA) is a rare central nervous system infection with high morbidity and mortality.
• Nonspecific clinical and imaging features often delay diagnosis, complicating treatment.
• Advances in antibiotics, neuroimaging, and surgical techniques have improved patient outcomes.

Purpose of the Study:

• To report a challenging case of ISCA initially misdiagnosed as a spinal tumor.
• To review the literature on ISCA, analyzing clinical features, diagnosis, and management.
• To emphasize the importance of high clinical suspicion and timely intervention for favorable outcomes.

Main Methods:

• Case report of a 65-year-old male with progressive spastic gait and lumbar pain.
• Initial MRI revealed a thoracic intramedullary cystic mass, treated with laminectomy, myelotomy, and abscess drainage.
• Systematic literature review of ISCA cases published between 1949 and May 2022.

Main Results:

• The patient initially improved after abscess drainage but later required decompression for a tethered spinal cord.
• Literature review highlighted diagnostic challenges due to rarity and coexisting spinal pathologies.
• Timely diagnosis and intervention are critical for reducing mortality and improving neurological function.

Conclusions:

• ISCA diagnosis requires a high index of suspicion, especially when clinical presentations are misleading.
• Multidisciplinary management involving neurosurgery and infectious disease specialists is essential.
• Long-term follow-up is necessary to detect and manage potential abscess recurrences.