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Purpose Congenital dermal sinuses are a rare form of spinal dysraphism. The developmental defects are located along the midline neuroaxis, with sinuses in the cervical region being the least common. Congenital dermal sinuses can be associated with intraspinal infection as they act as a direct route from the skin and subcutaneous tissues into the spinal cord. Methods The authors present two cases of cervical dermal sinuses complicated by intramedullary abscess. Both children presented with neurological decline and febrile illness. MRI showed intraspinal abscess. Both underwent prompt surgical excision of the sinus tract, exploration of the cord and intravenous antibiotics. Results Both patients demonstrated excellent neurological recovery. Conclusions Complete surgical excision of the sinus and tract in addition to long-term antimicrobials can yield excellent neurological outcomes. At surgery, do not expect to find pus when exploring the intramedullary component. Long-term follow-up is advocated due to potential late recurrence.

Spinal intramedullary abscesses are rare and potentially devastating lesions. Infection is mostly caused by staphylococci. Anaerobes are rare and often polymicrobial. We report an unusual case of spinal cord intramedullary abscess in a 7-month-old infant with monomicrobial infection due to Finegoldia magna. She was found to have a missed congenital thoracic dermal sinus. The patient was treated with metronidazole and ceftriaxone for 8 weeks, and improvement of the infection was documented. Clinical awareness of patients at risk is crucial for early diagnosis and intervention. As detection methods continue to improve for Finegoldia magna, it is important to increase awareness of the pathogenic role of this organism.

Spinal abscess in pediatric age group is a rare entity. Tubercular type is even rarer and it has been found to be associated with patent dermal sinus. Very few cases have been reported so far.We present a 2-month-old baby with gradually progressing paraparesis. There was a small dermal sinus in the lower area of right buttock which was discharging pus. MRI was done which showed intramedullary fluid collection at the level of lower lumbar and sacral spine suggesting abscess formation. Patient party was suggested for surgical exploration and histopathological evaluation. However, they denied and thus baby was put on steroid therapy. The baby gradually improved. However he started having paraparesis again and even worse than before. Repeat MRI showed intramedullary collection more than the previous MRI. Again surgical option was given and finally surgery done. Right hemilaminectomy was done from L3-4-5-S1and dura exposed. Dura was incised and spinal cord, conus and cauda equina exposed which were swollen and congested. Midline myelotomy was done opening the intramedullary. Free flow of thick pus was observed. Dermal sinus was excised and closed.Pus and small pieces of granulation tissue was sent for culture and cytological examination which showed features of tuberculosis. Antitubercular treatment was started and the baby became much better.Nepal Journal of Neuroscience 12:43-45, 2015

Although lumbar puncture (LP) is a relatively straightforward procedure and is usually associated with low morbidity, rare and significant neurological complications can occur. Intramedullary spinal cord abscess (ISCA) after lumbar puncture is one of these serious complications; however, this complication has not yet been reported in children.After 27 days in another medical facility, a 1-year-old girl was admitted to our hospital with a diagnosis of fever of unknown origin. Prior to the second admission, she had undergone multiple traumatic LP attempts. The patient was referred to our institution with progressive and ascending weakness. Three days later, this weakness involved all of the patient's four limbs. A LP was performed and showed purulent cerebrospinal fluid (CSF). An emergent spinal magnetic resonance imaging was performed and revealed an intramedullary lesion extending from the T2 to L3 level. Broad-spectrum antibiotics and steroids were administered to the patient, and a T2-L3 laminectomy was performed. The postoperative course was uneventful, but a neurologic deficit, including lower limb paralysis, remained.The index of suspicion for a pyogenic infection of the intramedullary space should be higher if progressive flaccid paralysis develops within a few days after a lumbar procedure. Nevertheless, the diagnosis may be challenging due to the rarity of this condition. Any misdiagnosis or delay of adequate treatment may lead to unfavorable outcomes.

Summary Intramedullary spinal cord abscess (ISCA) is a rare entity in the central nervous system, especially in patients without meningitis. It is often difficult to promptly establish the diagnosis. In this report, we describe the case of a woman 52 years of age who presented with progressive neck pain that was followed by rapidly worsening quadriparesis. The cervical spine magnetic resonance imaging revealed an ovoid lesion at the level of C2-C4 with a gadolinium contrast ring enhancement. Because ISCA was suspected, we performed surgery to decompress the cervical spinal cord. The bacterial culture of the cystic content revealed the growth of two bacteria, Fusobacterium nucleatum and Peptoniphilus asaccharolyticus, which have rarely been observed. The patient's postoperative course was uneventful and her outcome was excellent on discharge. Antibiotics were prescribed for 6 weeks. We further report the result of a literature review on the management of ISCA. The surgical indications for ISCA are controversial, but early surgery to decompress the spinal cord and confirm bacterial growth is recommended in rapidly worsening cases.

Spinal congenital dermal sinus is a rare entity. Still rarer is its location over the thoracic and cervical spine. Secondary to congenital dermal sinus, intramedullary abscesses of the spinal cord are uncommon. Only few cases of such an association have been reported in the literature. We report such an interesting case of thoracic spinal congenital dermal sinus associated with intramedullary abscess in an 18-month-old boy who presented with a diagnostic conundrum. The pathogenesis, clinical presentation, neuroimaging and management of such cases are discussed. Awareness, detection, timely referral and definitive operative intervention for a better neurological outcome are emphasized.

✓ An intramedullary abscess of the spinal cord (IASC) represents a rare disease associated with a potentially devastating outcome. Few cases involving children suffering from an IASC have been reported in the neurosurgical literature. In the majority of the reported pediatric cases there were either congenital abnormalities, such as a dermal sinus, or signs of local infections leading to a secondary hemopoietic spread. The authors report the case of an 18-month-old girl with an extensive IASC associated with an epidermoid cyst extending from T-11 to S-2 without evidence of a dermal sinus or history of clinically apparent systemic infection. To their knowledge, this is the first case report of an IASC without a condition facilitating either direct contamination via a dermal sinus or hemopoietic spread from an infectious focus outside the central nervous system. Signs and symptoms, the clinical course, and imaging features are discussed and the relevant literature is reviewed.

Study design: A rare case of a holocord intramedullary abscess with review of literature. Objectives: Summary of clinical presentation, radiology, microbiology, etiology and management of intramedullary spinal cord abscess. Abscess involving the entire spinal cord is extremely rare and awareness of such an event could avoid delay in evacuation of the absess. Methods: The incidence, clinical presentation, radiological investigations, treatment and etiology of intramedullary spinal cord abscess in 100 consecutive cases are discussed. Results: Intramedullary spinal cord abscesses are rare. Presently, only five cases of holocord intramedullary abscess are described. In our analysis of 100 cases of intramedullary abscess, a male preponderance was found. The first and the third decades were the most common age groups. Prognosis is poor if treatment is delayed. Contrast-enhanced MRI is the ideal investigation for diagnosis. Prompt surgical drainage of the abscess with appropriate antibiotic therapy is mandatory since the natural course of the disease has a very unfavourable outcome. Staphylococcus and Streptococcus were the most common causative organisms. Conclusion: Intramedullary spinal cord abscess along the entire length of spinal cord is rare. A thorough history with precise clinical localisation, a high index of suspicion, contrast-enhanced MRI at appropriate level and prompt surgical drainage with appropriate antibiotic therapy are key to the eventual outcome and prognosis.

Penetrating spinal injuries by wooden foreign body (WFB) is rare 1 . We present a 52 year-old man with a cervical spine injury by a WFB, identified 172 days after the accident, with an intramedullary abscess. Surgical intervention and antibiotic treatment led to neurological improvement.

Intramedullary abscess of the spinal cord (IASC) is a rare infecion of the central nervous system (CNS) with less than 150 cases eported in the literature. Early diagnosis and prompt treatment s essential to prevent significant morbidity and mortality associted with this condition. We report a patient with a high cervical ASC caused by Streptococcus milleri who presented with Brown equard Syndrome, progressed on to develop bulbar symptoms, ydrocephalus and ventriculitis and became comatosed and who ad a successful outcome as a result of aggressive surgical and edical management. To the best of our knowledge, this is the rst reported case of this complex presentation of intramedullary bscess of the spinal cord with a successful outcome.

Intramedullary spinal cord abscess secondary to dorsal dermal sinus is a rare entity and involvement of the entire length of spinal cord is even rarer. A thorough history with precise clinical localization, a high index of suspicion, Magnetic Resonance Imaging (MRI) of spine and prompt surgical drainage with appropriate antibiotic therapy are key to the eventual outcome and prognosis.

We report a case of an intramedullary spinal cord abscess (ISCA) in a 14-month-old child. This case demonstrates clinical and radiological features and emphasizes the importance of early diagnosis and treatment. Early surgical intervention and adjuvant antibiotic therapy have been shown to improve the clinical outcome. Successful outcome depends on early diagnosis and aggressive management. Spinal intramedullary abscess is a rare neurosurgical entity. They can hardly be distinguished from neoplasms. Hart described the first case in 1830. Since then, approximately 70 cases have been reported. An acute spinal intramedullary abscess may present as a cord syndrome with back pain and fever, contrasting with chronic spinal intramedullary abscess, which tends to have a less specific symptomatology.

Intramedullary spinal cord abscesses are relatively uncommon. We report the first case of an intramedullary spinal cord abscess in a preexisting spinal cord ependymoma. The clinical features and pathogenesis are discussed. Salient features of the management of intramedullary spinal cord abscesses are outlined.

A case of intramedullary abscess of the spinal cord in a child aged 3 years is reported. Successful outcome depends on early diagnosis and aggressive management.

Nocardial spinal cord abscesses are extremely rare. Only three have been reported, one each from Austria, Thailand, and the United States. All three patients also had extraneurologic nocardiosis. We present the first case of an intramedullary abscess caused by Nocardia asteroides and without concomitant extraneurologic nocardiosis. It is also the first such abscess in a living human being to be diagnosed by both magnetic resonance imaging and tissue culture. Resolution was complete after treatment.

• Listeria monocytogenes organisms were isolated from an intramedullary abscess in the cervical part of the spinal cord of an afebrile, previously healthy man who was occupationally exposed to farm animals. Acute neurologic abnormalities developed after a lumbar puncture, and cord widening was shown by myelography. Surgical decompression and antibiotic treatment for four weeks resulted in apparent bacteriologic cure with moderate neurologic sequelae.

Background Intramedullary abscess is a rare neurosurgical condition that usually arises in the setting of penetrating trauma to the spinal cord, infected congenital dural sinuses, or tuberculosis. Case presentation We describe a case of a 35-year-old African American male who presented with sepsis and a clinical picture of meningitis. The patient continued to have declining neurological status with decreasing sensation and worsening motor strength in all four extremities. He was found to have an intramedullary abscess in the cervical spinal cord that was treated with a decompressive posterior cervical laminectomy and drainage. The patient began to have a partial recovery of neurological function postoperatively. We also review the literature on intramedullary abscess that suggests the clinical presentation of our patient was a rare complication of acute meningitis. Conclusions Intramedullary abscess formation is a rare entity, and a high index of suspicion for intramedullary abscess is the key for making the diagnosis and expediting treatment for these patients.

✓ A case is presented in which an intramedullary abscess of the spinal cord resulted from a high spinal puncture. Laminectomy and drainage were followed by complete cure.