Artikel
Chronic intramedullary abscess: a case report and review of the literature
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Autoren
Veröffentlicht: | 4. Mai 2005 |
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Gliederung
Text
Objective
Intramedullary spinal cord abscesses are very rare. We present here a new case of this pathology, revealed by a progressive spinal cord compression. This case is particular because of the long follow-up before the surgery (two years).
Methods
This sixty eight years old patient has presented a gradually progressive paraparesis and sensory loss associated with legs pain. The past medical history was dominated by a tongue epidermoid cancer treated by surgery and radiotherapy. The MRI has shown an intramedullary mass lesion at the T10 level (8 mm). At T1-weighted sequences, the lesion was isointensive with the spinal cord, gadolinium infusion showed a homogeneous enhancement of the lesion. T2-weighted sequences showed decreased signal of the lesion with increased signal around (edema).
The others investigations gave no more information, particularly the lumbar puncture were normal. Corticoid infusions relieved the symptomatology so the patient refused the operation. Two episodes of regressive paraplegia with sphincter disturbances were treated by the same infusions. The patient has accepted the intervention with the third episode. The MRI realised after each episode, the only modification is edema which increase with the deficit and decrease after corticoid infusions.
Results
The intervention was performed two years after the first signs. We find a hard white mass lesion griped to the spinal cord. Pathologic examination showed infectious inflammation with acute and chronic micro-abscesses. Bacteriological cultures found a Streptococcus sanguis. This bacterium came from pathological teeth.
The initial out comes showed an intestinal perforation (Ogilvi syndrome). After this episode the patient could walked and one and half year later a minimal deficit persists.
Conclusions
First, the diagnosis was evoked but no retain because of the long evolution. The corticoid infusions gave a benefit and never increase the deficit. The MRI images were the same along two years except edema.
Intramedullary spinal cord abscesses are very rare. It’s very important to this pathology because of the morbidity and possible death without treatment. The evolution of our patient is very particular because of the symptomatology regression and non modified MRI images in spit of adequate treatment before surgery.