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Intramedullary spinal cord abscess with brain abscess due to subacute infective endocarditis
Weigang Luo1, Yuanyuan Yin1, Wanhu Liu1
1Department of Neurology, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
Background:
Intramedullary spinal cord abscesses (ISCA) are rare, even more so in association with brain abscesses. Infective endocarditis is an uncommon cause of ISCA. In this case study, we report a patient with intramedullary abscesses and multiple brain abscesses due to subacute infective endocarditis.
Case Presentation:
A 54-year-old man presented with a 7-day history of head and neck pain and numbness in both lower limbs. Intramedullary abscess combined with multiple brain abscesses was diagnosed based on blood culture, head and spinal magnetic resonance imaging (MRI), contrast-enhanced MRI, and magnetic resonance spectroscopy. Echocardiography revealed vegetations on the mitral valve and severe mitral regurgitation, which the authors believe was caused by subacute infective endocarditis. With ceftriaxone combined with linezolid anti-infective therapy, the patient's symptoms and imaging was improved during follow-up.
Conclusions:
This case hopes to raise the vigilance of clinicians for ISCA. When considering a patient with an ISCA, it is necessary to complete blood culture, MRI of the brain and spinal cord, and echocardiography to further identify whether the patient also has a brain abscess and whether the cause is infective endocarditis.
Insights
This case study highlights a rare instance of intramedullary spinal cord abscesses (ISCA) and brain abscesses caused by infective endocarditis. Early diagnosis via imaging and blood cultures is crucial for effective treatment of these serious infections.
Area of Science:
- Neurology
- Infectious Diseases
- Cardiology
Background:
- Intramedullary spinal cord abscesses (ISCA) are rare neurological emergencies.
- Infective endocarditis is an infrequent cause of ISCA, making combined presentations exceptionally uncommon.
- This case presents a unique scenario of co-occurring ISCA and multiple brain abscesses.
Observation:
- A 54-year-old male presented with acute neurological deficits including head/neck pain and lower limb numbness.
- Diagnostic imaging, including MRI of the brain and spine, revealed disseminated abscesses.
- Subacute infective endocarditis with mitral valve vegetations was identified as the underlying cause.
Findings:
- The patient was diagnosed with simultaneous intramedullary spinal cord and multiple brain abscesses.
- Blood cultures and echocardiography confirmed infective endocarditis as the etiology.
- Treatment with ceftriaxone and linezolid led to clinical and radiological improvement.
Implications:
- This case underscores the importance of considering infective endocarditis in patients with ISCA.
- Comprehensive diagnostic workup, including neuroimaging and echocardiography, is vital for identifying co-existing brain abscesses and the root cause.
- Increased clinical vigilance is recommended for diagnosing rare neurological infections linked to endocarditis.
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01:18Endocarditis III: Medical Management
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