eMedicine Specialties > Emergency Medicine > Neurology

Spinal Cord Infections: Differential Diagnoses & Workup

Author: Andrew K Chang, MD, Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center
Contributor Information and Disclosures

Updated: Sep 14, 2009

Differential Diagnoses

Epidural and Subdural Infections

Other Problems to Be Considered

Transverse myelitis
Intervertebral disk herniation
Intraspinal tumor
Spinal cord compression

Workup

Laboratory Studies

  • A complete blood count (CBC) demonstrates leukocytosis only in the acute presentation (with or without neutrophilia).
  • Cerebrospinal fluid (CSF) analysis demonstrates the following:
    • Marked pleomorphic leukocytosis, increased protein level, and decreased glucose and chloride level may be noted in the rare patients in whom the abscess has ruptured into the subarachnoid space.
    • Often, mild leukocytosis (mostly polymorphonucleocytes) and protein level increase are observed.
  • Results from blood cultures occasionally are positive, showing the bacteriology of the underlying disease (eg, bacterial endocarditis, urosepsis).
  • CSF cultures usually are sterile.

Imaging Studies

  • Cervical, thoracic, or lumbar spine radiographs
    • Plain films are not helpful in diagnosing spinal cord abscesses and usually are normal.
    • If plain films show diskitis, osteomyelitis, or paraspinal infection, then one should suspect spread of contiguous infection into the spinal cord.
    • However, in patients in whom the abscess is associated with dysraphism, spina bifida can be demonstrated.
  • Myelography with contrast
    • A positive myelogram reveals an expanded spinal cord or a complete block.
    • Until recently, myelography was the most reliable diagnostic tool; MRI largely has replaced it.
  • Magnetic resonance imaging
    • To date, in the cases reported using MRI, the T1-weighted images exhibit decreased signal intensity. Peripheral enhancement, similar to that observed with abscesses of the brain, has been found with gadolinium.
    • MRI has become the preferred imaging technique, yielding not only the diagnosis but also the extent of the process.

Procedures

  • Lumbar puncture
    • Do not attempt lumbar puncture if a dermal sinus is found in the lumbar area. Delay the procedure until a tethered cord syndrome has been excluded using computed tomography of the lumbar spinal canal.
    • Abdominal and jugular compression maneuvers with proper manometry may be indicated to establish the presence of a block to CSF flow. CSF manometer has been supplanted by neuroimaging, particularly MRI.
    • Jugular compression for manometric testing never should be performed if an intracranial mass is present.

More on Spinal Cord Infections

Overview: Spinal Cord Infections
Differential Diagnoses & Workup: Spinal Cord Infections
Treatment & Medication: Spinal Cord Infections
Follow-up: Spinal Cord Infections
Multimedia: Spinal Cord Infections
References
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References

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Further Reading

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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.

Medical Editor

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

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

J Stephen Huff, MD, Associate Professor, Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia Health Sciences Center
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.

CME Editor

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, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
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

 
 
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