Spinal Cord Infections Clinical Presentation

  • Author: Andrew K Chang, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Feb 14, 2011
 

History

Menezes and VanGilder have classified patients by the duration of symptoms into acute, subacute, and chronic categories.[3] In one study, the average time from the onset of symptoms to diagnosis was 46 days, with a range of 0-540 days.

Patients in the acute category present with symptoms lasting less than 1 week. Patients who present acutely have a clinical picture of transverse myelitis (with rapid onset of motor and sensory loss) and sphincter disturbances. Pain is common, and fever with signs of concomitant infection typically is present.

Patients in the subacute category present with symptoms that are 1-6 weeks old. The clinical picture resembles that of a chronic presentation.

Those in the chronic category present with symptoms of greater than 6 weeks' duration. Patients with chronic spinal cord abscesses present with signs and symptoms that are more consistent with an intramedullary tumor (ie, with a slowly progressive and stuttering neurologic deficit). Patients may complain of a radicular-type pain and are frequently afebrile.

Radiculopathic pain can present in the back, neck, extremities, or, occasionally, as abdominal or chest pain of undetermined origin. At least one reported case exists in which abdominal surgery was performed and later diagnosis proved intramedullary abscess of the spinal cord to be the origin of the problem.

A review of 25 patients, published in 1998, revealed fever in 40%, back or radicular pain in 60%, and a triad of fever, pain, and neurologic deficits in 24%.[1]

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Physical

A thorough physical examination to determine the extent of the motor and sensory deficit and its levels is of primary importance to guide diagnostic modalities later. Examine the cervical, dorsal, and lumbar regions carefully looking for dermal sinuses, suggestive lesions, and signs of local infection.

First findings of intramedullary spinal cord abscess include fever (in acute forms), radiculopathic pain, and neurologic deficit.

Root pain can present along a well-defined dermatome or, occasionally, as abdominal or chest pain of undetermined origin.

Palpation of the spinous processes or straight-leg raising is unlikely to elicit pain on examination.

Motor deficit usually progresses from slight paresis of one or more limbs to a flaccid paraplegia or tetraplegia with sensory loss below the level of the lesion and eventual sphincter disturbances (urinary retention or incontinence and/or loss of rectal tone).

A review of 25 patients, published in 1998, revealed the following:[1]

  • Motor deficits only (24%)
  • Sensory deficits only (4%)
  • Motor and sensory deficits (68%)
  • Brainstem dysfunction (4%)
  • Urinary incontinence (56%)
  • Meningismus (12%)
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Causes

Presence of spinal dysraphism (congenital midline neuroectodermal defects) with persistent dermal sinus can lead to development of an intramedullary abscess by contiguity. These abscesses usually are observed early in life. In a review of 25 patients, 36% had spinal dysraphisms.[1] Tethered cord syndrome can lend itself to iatrogenic spinal cord infection and damage via a lumbar puncture.

The existence of chronic conditions (eg, alcoholism, diabetes, intravenous drug use) can predispose patients to the development of this rare pathology of intramedullary abscess.

Immunosuppression (eg, AIDS) alters the bacteriology of spinal abscesses.

Organisms also can cause spinal cord infections.

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Contributor Information and Disclosures
Author

Andrew K Chang, MD  Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center

Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel J Dire, MD  FACEP, FAAP, FAAEM, Clinical Professor, Department of Emergency Medicine, University of Texas Medical School at Houston; Clinical Professor, Department of Pediatrics, School of Medicine, University of Texas Health Sciences Center San Antonio

Daniel J Dire, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, and Association of Military Surgeons of the US

Disclosure: Talecris Biotherapeutics Honoraria Speaking and teaching

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

J Stephen Huff, MD  Associate Professor of Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia School of Medicine

J Stephen Huff, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

References

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Graph showing age distribution of 91 patients with intramedullary spinal cord abscess. The age or gender of 14 patients is unknown.
 
 
 
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