A Rare Case of Cervical Intramedullary Spinal Cord Abscess

Abstract

Intramedullary spinal cord abscess (ISCA) is an exceptionally rare pathological condition with the potential to affect any segment of the spinal cord. The involvement of the cervical cord, however, is notably uncommon, with only 36% of the ISCA localised to this region. The authors present the case of a 67-year-old male who exhibited atypical clinical manifestations, including chronic neck and shoulder pain, and an acute onset of right sided weakness. Diagnostic imaging revealed a bi-loculated intramedullary ring enhanced lesion, suggestive of an ISCA. Initial intervention comprised of a cervical laminectomy and aspiration of the abscess. Despite this, the patient experienced progressive neurological decline involving all four limbs, necessitating a revision surgery with myelotomy. This was supplemented with an extended course of targeted antibiotic therapy guided by culture and sensitivity results. The patient subsequently demonstrated a gradual improvement in neurological function through comprehensive rehabilitation measures. In this instance, the ISCA was determined to be cryptogenic in origin. The patient’s extensive comorbid conditions, coupled with the use of immunosuppressive medications, were likely contributory factors to the pathogenesis of the abscess. Importantly, a centrally located spinal cord abscess is less prone to cause irreversible vascular compromise compared to an epidural abscess. Thus, early detection and prompt treatment are essential to mitigating significant morbidity and mortality associated with this condition.