Nocardial Osteomyelitis of the Spine with Epidural Spinal Cord Compression-a Case Report

Neurosurgery ◽  
1984 ◽  
Vol 15 (2) ◽  
pp. 254-256 ◽  
Author(s):  
Issam Awad ◽  
Janet W. Bay ◽  
John M. Petersen
Keyword(s):  
Vertebral Osteomyelitis ◽  
Cord Compression ◽  
Nocardia Asteroides ◽  
Sensory Level ◽  
Thoracic Myelopathy ◽  
Underlying Malignancy ◽  
Rare Manifestation ◽  
Specimen Processing ◽  
Epidural Compression ◽  
Diagnostic Work

Abstract A 53-year-old man presented with complaints of back pain and weakness in his lower extremities. Physical examination demonstrated a thoracic myelopathy with a sensory level at T-4, The diagnostic work-up revealed vertebral osteomyelitis of the thoracic spine with epidural compression at T-2-T-4 causing a nearly complete block on myelography. A decompressive laminectomy and debridement were performed, followed by anterior spinal fusion. Nocardia asteroides was cultured from the epidural space. The patient was concurrently treated with sulfonamides. No underlying malignancy or immunosuppression could be demonstrated, but a primary pulmonary nocardial infection was suspected. A satisfactory recovery was accomplished. Only four other cases of nocardial osteomyelitis of the spine have been reported in the literature. These are discussed, and possible mechanisms are proposed for the pathophysiology of this rare manifestation. Current recommendations on the specimen processing, diagnosis, and therapy of nocardial infections are briefly reviewed.

scholarly journals T11/T12 ossification of the yellow ligament contributing to thoracic myelopathy in patient with posterior fossa arachnoid cyst and acquired incidental Chiari I malformation/syrinx

2021 ◽  
Vol 12 ◽  
pp. 246
Author(s):  
Toshiya Aono ◽  
Hideaki Ono ◽  
Takeo Tanishima ◽  
Akira Tamura ◽  
Isamu Saito
Keyword(s):  
Lower Extremity ◽  
Posterior Fossa ◽  
Arachnoid Cyst ◽  
Cord Compression ◽  
Chiari I Malformation ◽  
Case Description ◽  
Thoracic Myelopathy ◽  
Chiari I ◽  
New Onset

Background: Thoracic ossification of the yellow ligament (OYL) may contribute to myelopathy. In the case presented, the patient additionally had a chronic posterior fossa arachnoid cyst with an acquired Chiari I malformation and cervicothoracic syrinx. Case Description: A 40-year-old female with a posterior fossa arachnoid cyst found 17 years ago, and newly acquired Chiari I malformation (tonsils down 5 mm) with a C7-T5 syrnix, presented with the new onset of lower extremity myelopathy. The MR documented marked dorsolateral cord compression due to T11/T12 OYL. Six months following a laminectomy for resection of OYL, the patient was asymptomatic. Conclusion: In patients presenting with the new onset of lower extremity myelopathy, evaluation of the complete neuraxis may be warranted. Here, the patient has an unchanged posterior fossa arachnoid cyst with an acquired Chiari I malformation/C7-T5 syrinx. However, the patient’s symptoms were fully attributed to the MR-documented T11/T12 OYL that was successfully resected.

scholarly journals Thromboembolic Central Nervous System Complications of COVID-19

2021 ◽  
Author(s):  
Caio Disserol ◽  
Alessandra Filpo ◽  
Taís Luise Denicol ◽  
Bruno Della-Ripa ◽  
Francine Mendonça ◽  
...  
Keyword(s):  
Ct Angiography ◽  
Holter Monitoring ◽  
Sudden Onset ◽  
Initial Assessment ◽  
Nasopharyngeal Swab ◽  
Sensory Level ◽  
Csf Analysis ◽  
Neurological Exam ◽  
Diagnostic Work ◽  
A Minor

Context: COVID-19 is well-known to increase the risk of developing thromboembolism; thus, patients may present with diverse neurovascular manifestations. Case report: A 56-year-old man presented with sudden onset of incoordination of his left arm and leg. He also had a history of recurrent episodes of transient left hemithoracic pain radiating to his left arm, along with right visual hemi-field positive phenomena. Additionally, he reported self-limited fever and anosmia three weeks earlier. Examination revealed left hemiataxia (NIHSS score: 2). Initial assessment with brain CT, intracranial and cervical CT angiography was normal. Shortly after admission, the patient developed acute weakness of his four limbs and urinary retention. Neurological exam showed left homonimous hemianopia, asymmetric tetraparesis and a superficial sensory level at C4. Neuraxis MRI was performed and diffusion-weighted imaging revealed acute ischemic lesions in the occiptal lobes, cerebellum and cervicalthoracic spine. A thorough diagnostic work-up was conducted. Laboratory tests were unremarkable, including inflammatory markers, viral hepatitis, HIV and syphilis serologies, as well as rheumatologic tests and a thrombophilia panel, except for SARS-COV-2 serology, with detection of IgM antibodies. RT-PCR nasopharyngeal swab was negative. Further investigation with CSF analysis, CT angiography of the aorta, transthoracic echocardiogram, 24-hour holter monitoring and transcranial Doppler didn’t show any abnormalities. Transesophageal echocardiogram revelead a minor patent foramen ovale. Conclusion: This is a case of acute cerebral, cerebellar and spinal embolic infarction, probably related to Covid-19, illustrating the infection’s associated coagulopathy¹.

scholarly journals Thoracic cryptococcal osteomyelitis mimicking tuberculosis: A case report

2019 ◽  
Vol 10 ◽  
pp. 81
Author(s):  
Nitin Adsul ◽  
K. L. Kalra ◽  
Nikhil Jain ◽  
Mukesh Haritwal ◽  
R. S. Chahal ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Vision Loss ◽  
Diagnostic Delay ◽  
Vertebral Osteomyelitis ◽  
Needle Aspiration ◽  
Cord Compression ◽  
Neurological Deficits ◽  
Cytologic Examination ◽  
Cryptococcal Infection ◽  
Organ Systems

Background: Isolated cryptococcal osteomyelitis of the spine is extremely uncommon; there have been only seven cases identified in literature. The majority were originally misdiagnosed as tuberculosis. Here, we present a patient with cryptococcal osteomyelitis of the thoracic spine with associated fungal retinal deposits. Case Description: A 45-year-old, type II diabetic female presented with a 5-month history of severe back pain. Her magnetic resonance imaging (MRI) revealed osteomyelitis involving the T4 vertebral body with epidural and prevertebral extension; notably, the intervertebral disc spaces were not involved. Although the fine-needle aspiration cytologic examination was inconclusive, the patient was empirically placed on antitubercular drug therapy. One month later, she became fully paraplegic. The MRI now demonstrated osteolytic lesions involving the T4 vertebral body with cord compression. She underwent biopsy of the T4 vertebral body and a transfacet T4 decompression with T2-T6 pedicle screw fixation. Culture and histopathological examinations both documented a cryptococcal infection, and she was placed on appropriate antifungal therapy. Notably, 3 weeks after surgery, she developed a sudden loss of vision loss due to retinal fungal endophthalmitis. She recovered vision in one eye after the administration of intravitreal voriconazole but lost vision in the other eye despite a vitrectomy. Over the next 8 months, she gradually recovered with motor function of 4/5 in both lower extremities without evidence of recurrent disease. Conclusion: Cryptococcal infection should be among the differential diagnostic considerations for patients with vertebral osteomyelitis. Notably, diagnostic delay can lead to devastating neurological deficits and involvement of other organ systems.

scholarly journals Cervical C7 ganglion cyst causing compressive myelopathy: A rare case report

2019 ◽  
Vol 10 ◽  
pp. 61
Author(s):  
Charandeep Singh Gandhoke ◽  
Siu Kei David Mak ◽  
Nishal Kishinchand Primalani ◽  
Eng Tah Goh ◽  
Hwei Yee Lee ◽  
...  
Keyword(s):  
Ganglion Cyst ◽  
Cord Compression ◽  
Sensory Level ◽  
Facet Joints ◽  
Complete Excision ◽  
Lower Extremity Weakness ◽  
Ganglion Cysts ◽  
Rare Case Report ◽  
History Of ◽  
Compressive Myelopathy

Background: Juxtafacet cysts, synovial and ganglion cysts, emanate from the facet joints. Patients with these cysts are typically asymptomatic but may rarely present with radiculopathy and/or myelopathy. Case Description: A 72-year-old female presented with a 1-month history of progressive lower extremity weakness (left more than right), numbness, and urinary incontinence. Notably, she also had a C7 sensory level to pin appreciation of 1-month duration. The magnetic resonance imaging showed an extradural C7 cystic lesion whose capsule enhanced with gadolinium, causing severe cord compression. The patient underwent a left C7 hemilaminectomy for complete excision of the cyst; postoperatively in 2-weeks duration, she regained full neurological function. The final histopathology was consistent with a ganglion cyst. Conclusion: Cervical juxtafacet cysts rarely cause compressive myelopathy. They may be readily diagnosed and resected with excellent postoperative outcomes.

Spinal Cord Compression Due to Anaerobic Vertebral Osteomyelitis in a Patient with Metastatic Prostate Cancer

1995 ◽  
Vol 21 (2) ◽  
pp. 457-458 ◽  
Author(s):  
S. Bilgrami ◽  
E. L. Pesanti ◽  
N. T. Singh ◽  
R. J. Cobb ◽  
L. L. Chen ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Metastatic Prostate Cancer ◽  
Vertebral Osteomyelitis ◽  
Cord Compression

scholarly journals Management of pyogenic vertebral osteomyelitis with spinal cord compression in the elderly

Spinal Cord ◽  
1992 ◽  
Vol 30 (11) ◽  
pp. 795-798 ◽  
Author(s):  
R Gepstein ◽  
Y Folman ◽  
C Lidor ◽  
V Barchilon ◽  
A Catz ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Vertebral Osteomyelitis ◽  
The Elderly ◽  
Cord Compression ◽  
Pyogenic Vertebral Osteomyelitis

Don't Wait for a Sensory Level–Listen to the Symptoms: a Prospective Audit of the Delays in Diagnosis of Malignant Cord Compression

2002 ◽  
Vol 14 (6) ◽  
pp. 472-480 ◽  
Author(s):  
P. Levack ◽  
J. Graham ◽  
D. Collie ◽  
R. Grant ◽  
J. Kidd ◽  
...  
Keyword(s):  
Cord Compression ◽  
Sensory Level ◽  
Prospective Audit ◽  
Delays In Diagnosis

Spinal Cord Compression Secondary to Idiopathic Retroperitoneal Fibrosis

Neurosurgery ◽  
1990 ◽  
Vol 26 (4) ◽  
pp. 678-681 ◽  
Author(s):  
João de Sá ◽  
José Pimentel ◽  
Mamede Carvalho ◽  
Pedro Evangelista ◽  
Paulo Martins
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Retroperitoneal Fibrosis ◽  
Cord Compression ◽  
Magnetic Resonance Imaging Scan ◽  
Resonance Imaging ◽  
Precise Location ◽  
Idiopathic Retroperitoneal Fibrosis ◽  
Fibrotic Tissue ◽  
Epidural Compression

Abstract Retroperitoneal fibrosis is a rare disorder in which the abnormal fibrotic tissue compresses retroperitoneal organs. In the majority of patients no obvious cause can be found, hence the name idiopathic retroperitoneal fibrosis. The process can also arise from other anatomic areas, suggesting a multifocal origin. We report a case of dorsal epidural compression in a 63-year-old patient harboring idiopathic retroperitoneal fibrosis. A magnetic resonance imaging scan revealed the precise location of the lesion. It is suggested that retroperitoneal fibrosis should be considered in the differential diagnosis of epidural spinal cord compression.

Sign in / Sign up

Export Citation Format

Share Document