Bulbo-medullary abscess’s management

Abstract

Background/introduction: Intramedullary spinal cord and brainstem abscesses are a rare pathological entity and they are usually associated with other infections. Bulbo-medullary abscesses are even rarer with a potentially good outcome if treated adequately. Case description: We present the case of a 34-year-old young woman presented with severe neck and shoulder pain, which progressed over several days to tetraparesis without any systemic infections. An emergent spinal magnetic resonance imaging was performed and revealed an intramedullary cervical lesion extending to the medulla oblongata suggesting bulbo-medullary abscess. The decision was made for an urgent microsurgical draining the purulent material to avoid further decline and completing a course of tailored antibiotics. The patient showed total recovery of his neurologic deficit with post operatory MRI demonstrating intramedullary cervical lesion suggesting dermoid cyst. Conclusion: Bulbo-medullary abscess is a rare complex life-threatening infection. The diagnosis may be challenging due to the rarity, and a multidisciplinary approach including medical therapy and surgical intervention, leads to a favorable outcome in this potentially lethal condition.

Keywords

• Intramedullary
• Brain stem
• Spinal cord
• Abscess
• Dermoid cyst