Cervical Osteomyelitis with Thoracic Myelitis and Meningitis in a Diabetic Patient

A 45-year-old man with a history of untreated diabetes mellitus had a persisting fever, back pain, and diarrhea. The primary care physician diagnosed the patient with the flu and gastroenteritis. The patient developed paraplegia for two weeks and was admitted to another hospital. The physician in this hospital suspected infectious meningitis and myelitis, and administered piperacillin and steroids without cerebrospinal fluid (CSF) examination. On referral to our hospital, he presented a high fever and complete paraplegia. The lumbar puncture revealed a yellowish CSF, polynucleosis, and hypoglycorrhachia. Bacteria were not detected on Gram's staining and were not confirmed by CSF culture. Magnetic resonance imaging (MRI) showed no thoracolumbar lesion and suggested a cervical epidural abscess without any spinal cord compression. He was diagnosed as having osteomyelitis with meningitis and thoracic myelitis. The infection subsided with broadspectrum antibiotics. After two weeks, bilateral sensorimotor disturbances of the upper extremities appeared. MRI findings showed the epidural abscess compressing the cervical spinal cord. We performed debridement of the epidural abscess. The infection was clinically controlled by using another antibiotic. One month after the infection subsided, a 360° reconstruction was performed. In this case, the misdiagnosis and the absence of CSF examination and culture to detect the pathogenic bacteria at an earlier stage in the patient's disease course might have led to the exacerbation of the pathology.

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Posttraumatic Spinal Cord Injury without Radiographic Abnormality

Advances in Orthopedics ◽

10.1155/2018/7060654 ◽

2018 ◽

Vol 2018 ◽

pp. 1-10 ◽

Cited By ~ 5

Author(s):

Kivanc Atesok ◽

Nobuhiro Tanaka ◽

Andrew O’Brien ◽

Yohan Robinson ◽

Dachling Pang ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Cervical Spinal Cord ◽

Clinical Signs ◽

Cord Compression ◽

Plain Radiographs ◽

Radiographic Abnormality ◽

Recurrent Injury ◽

Cord Injury ◽

Magnetic Resonance Imaging Mri

“Spinal Cord Injury without Radiographic Abnormality” (SCIWORA) is a term that denotes objective clinical signs of posttraumatic spinal cord injury without evidence of fracture or malalignment on plain radiographs and computed tomography (CT) of the spine. SCIWORA is most commonly seen in children with a predilection for the cervical spinal cord due to the increased mobility of the cervical spine, the inherent ligamentous laxity, and the large head-to-body ratio during childhood. However, SCIWORA can also be seen in adults and, in rare cases, the thoracolumbar spinal cord can be affected too. Magnetic resonance imaging (MRI) has become a valuable diagnostic tool in patients with SCIWORA because of its superior ability to identify soft tissue lesions such as cord edema, hematomas and transections, and discoligamentous injuries that may not be visualized in plain radiographs and CT. The mainstay of treatment in patients with SCIWORA is nonoperative management including steroid therapy, immobilization, and avoidance of activities that may increase the risk of exacerbation or recurrent injury. Although the role of operative treatment in SCIWORA can be controversial, surgical alternatives such as decompression and fusion should be considered in selected patients with clinical and MRI evidence of persistent spinal cord compression and instability.

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Epidural Lipomatosis Simulating an Epidural Abscess: Case Report and Literature Review

Neurosurgery ◽

10.1227/00006123-198711000-00029 ◽

1987 ◽

Vol 21 (5) ◽

pp. 744-747 ◽

Cited By ~ 23

Author(s):

Regis W. Haid ◽

Howard H. Kaufman ◽

Sydney S. Schochet ◽

Gary D. Marano

Keyword(s):

Spinal Cord ◽

Epidural Abscess ◽

Cord Compression ◽

Fatty Tissue ◽

Epidural Lipomatosis ◽

Neurological Improvement ◽

Computed Tomographic ◽

Dose Corticosteroid ◽

Staphylococcus Aureus Pneumonia ◽

And Staphylococcus Aureus

Abstract A case of epidural lipomatosis in a 49-year-old man presenting with paraparesis, midthoracic pain, and Staphylococcus aureus pneumonia is reported. The patient had been on low dose corticosteroid therapy for 7 years for rheumatoid arthritis. The clinical and myelographic findings suggested a diagnosis of epidural abscess, but the only abnormality discovered at operation was abundant fatty tissue in the dorsal epidural space significantly compressing the spinal cord, and this was partially removed. Postoperative neurological improvement suggested that the lipomatosis was responsible for the spinal cord compression and dysfunction. If this diagnosis had been suspected, it might have been confirmed by magnetic resonance imaging or postmyelography computed tomographic scanning. With such a diagnosis, an alternative treatment could have been to decrease the steroid dose, observe for clinical improvement, and perhaps avoid operation. (Neurosurgery 21:744-747, 1987)

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An evaluation of the finger flexion, Hoffman's and plantar reflexes as markers of cervical spinal cord compression – A comparative clinical study

Clinical Neurology and Neurosurgery ◽

10.1016/j.clineuro.2015.04.009 ◽

2015 ◽

Vol 134 ◽

pp. 12-16 ◽

Cited By ~ 6

Author(s):

M.N. Tejus ◽

Vikram Singh ◽

Ananthakrishnan Ramesh ◽

V.R. Roopesh Kumar ◽

Ved Prakash Maurya ◽

...

Keyword(s):

Spinal Cord ◽

Clinical Study ◽

Spinal Cord Compression ◽

Cervical Spinal Cord ◽

Cord Compression ◽

Finger Flexion ◽

Comparative Clinical Study

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CT demonstration of cervical spinal cord compression—cause of reversible itching and burning in the lower extremities

Journal of Computed Tomography ◽

10.1016/0149-936x(82)90013-3 ◽

1982 ◽

Vol 6 (1) ◽

pp. 57-60 ◽

Cited By ~ 1

Author(s):

T.L. Ulicny ◽

K.J. Dastur ◽

G.H. Gray

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cervical Spinal Cord ◽

Lower Extremities ◽

Cord Compression

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Osteochondroma causing cervical spinal cord compression

Skeletal Radiology ◽

10.1007/s00256-017-2633-6 ◽

2017 ◽

Vol 46 (8) ◽

pp. 1125-1130 ◽

Cited By ~ 2

Author(s):

Ryunosuke Fukushi ◽

Makoto Emori ◽

Noriyuki Iesato ◽

Masanobu Kano ◽

Toshihiko Yamashita

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cervical Spinal Cord ◽

Cord Compression

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Prevalence of pre-existing factors causing spinal cord compression: Is there a difference between patients suffering from cervical spinal cord injury with and without bone injury?

Journal of Orthopaedic Science ◽

10.1016/j.jos.2021.06.004 ◽

2021 ◽

Author(s):

Kyoichi Handa ◽

Haruo Kanno ◽

Shigetsune Matsuya ◽

Hideki Imaizumi ◽

Eiji Itoi

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Spinal Cord Compression ◽

Cervical Spinal Cord ◽

Cord Compression ◽

Cervical Spinal Cord Injury ◽

Bone Injury ◽

Cord Injury

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Acute Transverse Myelitis Associated with COVID-19 vaccine: A Case Report

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v12i3.4818 ◽

2021 ◽

Vol 12 (3) ◽

pp. 2083-2087

Author(s):

Ali Alshararni

Keyword(s):

Spinal Cord ◽

Case Report ◽

Acute Inflammation ◽

Transverse Myelitis ◽

Preventive Measure ◽

Mri Findings ◽

Dorsal Spinal Cord ◽

Lumbosacral Spinal Cord ◽

Acute Transverse Myelitis ◽

Magnetic Resonance Imaging Mri

The case report demonstrates the issue of Khalid Ali, who is a citizen of Yamen, explicitly living in Saudi Arabia. He is 38 years, weighs 82kgs, and of 162 cm in height. He is a sales professional and married with two kids. Khalid Ali has been living healthy until two years ago when he started experiencing pains in his lower extremities accompanied by numbness. He was treated, and everything went back to normal until soon when the case came back after the administration of the Pfizer vaccine as a preventive measure for COVID-19 disease. The consequence of the administration of the Pfizer vaccine resulted in severe pain and weaknesses in his legs and severe headache on the second day, which resulted in him being put on an ICU after 48 hours since he was almost paralyzed. A series of tests were conducted on him, including magnetic resonance imaging (MRI), hematology, and biochemistry which involved Cerebrospinal Fluid (CSF) protein test. MRI findings were significant since they indicated acute inflammation on the spine observed on the dorsal spinal cord with contrast and lumbosacral spinal cord. All the hematology tests turned out to be expected. Biochemistry conducted tests were similarly standard except for CSF protein which was highly abnormal. The combination of the high abnormal CSF protein test and acute inflammation of the spine observed from the MRI findings were confirmed evidence of acute transverse myelitis as a result of the administration of the Pfizer vaccine.

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Cervical spinal cord compression in a child with cervicofacial actinomycosis

Brain and Development ◽

10.1016/j.braindev.2013.08.002 ◽

2014 ◽

Vol 36 (7) ◽

pp. 634-636 ◽

Cited By ~ 3

Author(s):

Po-Cheng Hung ◽

Huei-Shyong Wang ◽

Cheng-Hsun Chiu ◽

Alex M.-C. Wong

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cervical Spinal Cord ◽

Cord Compression

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Emergency Magnetic Resonance Examination of Patients with Spinal Cord Symptoms

Acta Radiologica ◽

10.1177/028418518802900115 ◽

1988 ◽

Vol 29 (1) ◽

pp. 69-75 ◽

Cited By ~ 17

Author(s):

E.-M. Larsson ◽

S. Holtås ◽

S. Cronqvist

Keyword(s):

Spinal Cord ◽

Magnetic Resonance ◽

Epidural Abscess ◽

Imaging System ◽

Epidural Haematoma ◽

Sudden Onset ◽

Surface Coils ◽

Signal Characteristics ◽

Traumatic Lesions ◽

Magnetic Resonance Imaging Mri

Eighteen consecutive patients with spinal cord symptoms of sudden or relatively sudden onset were examined with magnetic resonance imaging (MRI). The examinations were performed on a 0.3 tesla permanent/resistive imaging system using solenoidal surface coils. MRI revealed epidural tumour in five patients, intramedullary tumour in one, epidural abscess in one, myelitis in two, spontaneous intraspinal epidural haematoma in two, disc herniation in two, traumatic lesions in four and no abnormality in one patient. MRI was found to be capable of non-invasively and painlessly detecting and exactly defining the extent of intraspinal and paraspinal lesions. In some cases the nature of the lesion could be inferred from specific signal characteristics, which is a unique property of MRI. The results strongly suggest that MRI is superior to myelography and other imaging methods and should be regarded as the examination of choice in the emergency examination of patients with spinal cord symptoms.

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