P2. Concurrent intramedullary cervical spine abscess and intraventricular empyema

Abstract

BACKGROUND CONTEXT

Intramedullary spinal cord abscess (ISCA) and intraventricular empyema are both rare, severe infections that can result in significant neurological impairment or death if not managed promptly. Although each condition alone poses diagnostic and therapeutic challenges, the simultaneous occurrence of ISCA and intraventricular empyema is exceedingly uncommon. Recognizing these pathologies early and initiating aggressive treatment is essential to prevent irreversible CNS damage.

PURPOSE

To present a rare case of concurrent cervical intramedullary spinal cord abscess and intraventricular empyema, highlighting the diagnostic difficulties, the necessity of early surgical intervention, and the importance of comprehensive antibiotic coverage in managing complex central nervous system infections.

STUDY DESIGN/SETTING

This is a single-patient case report treated at a tertiary neurosurgical center, coupled with a review of the pertinent literature to contextualize the rarity and management of such concurrent CNS infections.

PATIENT SAMPLE

A 43-year-old female patient, with a history of cervical spine surgery (for ossification of the posterior longitudinal ligament), presented with a two-week history of fever, acute left upper limb weakness, numbness, and neck pain.

OUTCOME MEASURES

Key measures included neurological status (motor strength, level of consciousness), radiological evolution of the spinal and intraventricular infections (MRI findings), and response to antimicrobial therapy and surgical interventions (abscess drainage, external ventricular drainage, and shunt placement).

METHODS

An urgent surgical decompression and drainage of the intramedullary abscess at the C3–4 level was performed via a posterior approach. Antibiotics were initially broad-spectrum, then tailored to culture results identifying oral flora (Prevotella species and Fusobacterium nucleatum). When the patient’s mental status worsened, follow-up brain imaging revealed intraventricular empyema, requiring external ventricular drainage. After infection control was achieved, ventriculoperitoneal shunts were placed to address persistent hydrocephalus.

RESULTS

Despite initial deterioration in motor strength post-surgery, the patient demonstrated gradual neurological improvement with appropriate antibiotic therapy and serial interventions for both the spinal cord abscess and the intraventricular empyema. Final discharge status showed partial but meaningful recovery of left-sided strength, normal alertness, and resolution of severe headaches attributed to hydrocephalus.

CONCLUSIONS

Concurrent spinal cord abscess and intraventricular empyema demand high clinical suspicion and a coordinated, multidisciplinary approach. Early recognition, comprehensive antibiotic coverage (including coverage for potential oral flora), thorough surgical decompression of abscesses, and timely management of secondary complications like hydrocephalus are crucial for optimizing patient outcomes.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.