Laboratory Studies

A CBC count 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.

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.

MRI

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.

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.

Treatment & Management

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Media Gallery

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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Author

Andrew K Chang, MD, MS Vincent P Verdile, MD, Endowed Chair in Emergency Medicine, Professor of Emergency Medicine, Vice Chair of Research and Academic Affairs, Albany Medical College; Associate Professor of Clinical Emergency Medicine, Albert Einstein College of Medicine; Attending Physician, Department of Emergency Medicine, Montefiore Medical Center

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

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

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

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

Disclosure: Nothing to disclose.

Chief Editor

Liudvikas Jagminas, MD, FACEP Chief of Service, Attending Physician, Department of Emergency Medicine, Beth Israel Deaconess Medical Center; Vice-Chair for Network Development, Department of Emergency Medicine, Beth Israel Deaconess and Harvard Medical Faculty Physicians; Adjunct Associate Professor of Emergency Medicine, The Warren Alpert Medical School of Brown University

Liudvikas Jagminas, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, International Trauma Anesthesia and Critical Care Society, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Daniel J Dire, MD, FACEP, FAAP, FAAEM Professor of Pediatrics and Emergency Medicine, University of Texas Health Science Center at San Antonio, Joe R and Teresa Lozano Long School of Medicine

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, The Society of Federal Health Professionals (AMSUS)

Disclosure: Nothing to disclose.

Robert E O'Connor, MD, MPH Professor and Chair, Department of Emergency Medicine, University of Virginia Health System

Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Heart Association, American Medical Association, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.