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Cryptogenic cervical intramedullary abscess with rapidly progressive myelopathy: illustrative case

Nebras M Warsi1, Ann Wilson1, Armaan K Malhotra1

  • 11Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

Journal of Neurosurgery. Case Lessons
|September 22, 2022
PubMed

Insights

This case report details a rare cervical intramedullary abscess caused by Eikenella and Gemella bacteria. Prompt diagnosis and surgical intervention led to significant recovery, highlighting the importance of early management.

Area of Science:

  • Neurosurgery
  • Infectious Disease
  • Spinal Cord Pathology

Background:

  • Presents a rare case of rapidly progressive myelopathy in a 68-year-old female.
  • Highlights the diagnostic and therapeutic challenges of idiopathic cervical intramedullary abscess.

Observation:

  • Surgical laminectomy and aspiration revealed purulent material with Eikenella corrodens and Gemella morbillorum.
  • Postoperative antibiotics were administered; the patient showed significant recovery with residual hand dysesthesia at 6 months.
  • Extensive infectious workup, including dental and cardiac assessments, did not identify the infection source.

Findings:

  • First reported case of cryptogenic spinal intramedullary abscess due to coinfection with Eikenella spp. and Gemella spp.
  • Intramedullary abscesses are rare, especially in adults without typical risk factors like immunosuppression or congenital malformations.
  • The condition can be misdiagnosed as intramedullary neoplasms or demyelinating disease in adults.

Implications:

  • Emphasizes the critical need for prompt diagnosis and management of rapidly progressive myelopathy.
  • Highlights the importance of considering infectious etiologies, even in the absence of clear risk factors.
  • Targeted imaging and thorough infectious workup are crucial to prevent severe neurological deficits from spinal cord abscesses.
Abstract

Keywords:
CNS infectioncase reportintramedullary abscessneuroinfectious diseasespinal abscess

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