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Child's Nervous System
Published in: Child's Nervous System 7/2013

01-07-2013 | Case-Based Update

Intramedullary spinal cord abscess as complication of lumbar puncture: a case-based update

Authors: Paulo Sergio Lucas da Silva, Rafael Duarte de Souza Loduca

Published in: Child's Nervous System | Issue 7/2013

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Abstract

Introduction

Although lumbar puncture (LP) is a relatively straightforward procedure and is usually associated with low morbidity, rare and significant neurological complications can occur. Intramedullary spinal cord abscess (ISCA) after lumbar puncture is one of these serious complications; however, this complication has not yet been reported in children.

Case report

After 27 days in another medical facility, a 1-year-old girl was admitted to our hospital with a diagnosis of fever of unknown origin. Prior to the second admission, she had undergone multiple traumatic LP attempts. The patient was referred to our institution with progressive and ascending weakness. Three days later, this weakness involved all of the patient’s four limbs. A LP was performed and showed purulent cerebrospinal fluid (CSF). An emergent spinal magnetic resonance imaging was performed and revealed an intramedullary lesion extending from the T2 to L3 level. Broad-spectrum antibiotics and steroids were administered to the patient, and a T2–L3 laminectomy was performed. The postoperative course was uneventful, but a neurologic deficit, including lower limb paralysis, remained.

Conclusion

The index of suspicion for a pyogenic infection of the intramedullary space should be higher if progressive flaccid paralysis develops within a few days after a lumbar procedure. Nevertheless, the diagnosis may be challenging due to the rarity of this condition. Any misdiagnosis or delay of adequate treatment may lead to unfavorable outcomes.
Literature
1.
Aggarwal M, Aggarwal KC (2011) Karamchand, Aggarwal A. Intramedullary spinal cord abscess masquerading as spinal tumor Indian Pediatr 48:973–974
2.
Al Barbarawi M, Khriesat W, Qudsieh S, Qudsieh H, Loai AA (2009) Management of intramedullary spinal cord abscess: experience with four cases, pathophysiology and outcomes. Eur Spine J 18:710–717CrossRefPubMed
3.
Amini A, Liu JK, Kan P, Brockmeyer DL (2006) Cerebrospinal fluid dissecting into spinal epidural space after lumbar puncture causing cauda equina syndrome: review of literature and illustrative case. Childs Nerv Syst 22:1639–1641CrossRefPubMed
4.
Aniba K, Ghannane H, Naji R, Haddi M, Habiblah M, Jalal H et al (2007) Paraplegia revealing an intramedullary abscess: case report. Arch Pediatr 14:492–493CrossRefPubMed
5.
Baradaran N, Ahmadi H, Nejat F, El Khashab M, Mahdavi A, Rahbarimanesh AA (2008) Recurrent meningitis caused by cervico-medullary abscess, a rare presentation. Childs Nerv Syst 24:767–771CrossRefPubMed
6.
Benzil DL, Epstein MH, Knuckey NW (1992) Intramedullary epidermoid associated with an intramedullary spinal abscess secondary to a dermal sinus. Neurosurgery 30:118–121CrossRefPubMed
7.
Bergman I, Wald ER, Meyer JD, Painter MJ (1983) Epidural abscess and vertebral osteomyelitis following serial lumbar punctures. Pediatrics 72:476–480PubMed
8.
Bhatoe HS, Gill HS, Kumar N, Biswas S (1994) Post lumbar puncture discitis and vertebral collapse Postgrad Med J 70:882–884CrossRef
9.
Bunyaratavej K, Desudchit T, Pongpunlert W (2006) Holocord intramedullary abscess due to dermal sinus in a 2-month-old child successfully treated with limited myelotomy and aspiration Case report. J Neurosurg 104:269–274PubMed
10.
Byrne RW, von Roenn KA, Whisler WW (1994) Intramedullary abscess: a report of two cases and a review of the literature. Neurosurgery 35:321–326CrossRefPubMed
11.
Chan CT, Gold WL (1998) Intramedullary abscess of the spinal cord in the antibiotic era: clinical features, microbial etiologies, trends in pathogenesis, and outcomes. Clin Infect Dis 27:619–626CrossRefPubMed
12.
Chopra A, Patra B, Aneja S, Mukherjee S, Maheswari A, Seth A spinal congenital dermal sinus presenting as a diagnostic conundrum (2012) Pediatr Neurosurg 48:187–190
13.
du Plessis J, Andronikou S, Theron S, Wieselthaler N, Hayes M (2008) Unusual forms of spinal tuberculosis. Childs Nerv Syst 24:453–457CrossRefPubMed
14.
Gerlach R, Zimmermann M, Hermann E, Kieslich M, Weidauer S, Seifert V (2007) Large intramedullary abscess of the spinal cord associated with an epidermoid cyst without dermal sinus. Case report J Neurosurg Spine 7:357–361CrossRef
15.
Guzel N, Eras M, Guzel DK (2003) A child with spinal intramedullary abscess. Childs Nerv Syst 19:773–6CrossRefPubMed
16.
Hanigan WC, Asner NG, Elwood PW (1990) Magnetic resonance imaging and the nonoperative treatment of spinal epidural abscess. Surg Neurol 34:408–413CrossRefPubMed
17.
Helvaci M, KasIrga E, Cetin N, Yaprak I (2002) Intramedullary spinal cord abscess suspected of Brucella infection. Pediatr Int 44:446–448CrossRefPubMed
18.
Houx L, Brochard S, Peudenier S, Dam Hieu P, Remy-Neris O (2011) Recovery after tetraplegia caused by dermal sinus infection: intramedullary abscess and tetraparesis. Pediatr Neurol 44:229–232CrossRefPubMed
19.
Hung PC, Wang HS, Wu CT, Lui TN, Wong AM (2007) Spinal intramedullary abscess with an epidermoid secondary to a dermal sinus. Pediatr Neurol 37:144–147CrossRefPubMed
20.
Janssens E, Aerssens P, Alliet P, Gillis P, Raes M (2003) Post-dural puncture headaches in children: a literature review. Eur J Pediatr 162:117–121CrossRefPubMed
21.
Joffe AR (2007) Lumbar puncture and brain herniation in acute bacterial meningitis: a review. J Intensive Care Med 22:194–207CrossRefPubMed
22.
23.
Kamgarpour A, Izadfar MA, Razmkon A (2008) Neglected intramedullary cord abscess in a 3-year old child: a case report. Childs Nerv Syst 24:153–155CrossRefPubMed
24.
Keihani-Douste Z, Daneshjou K, Ghasemi M (2006) A quadriplegic child with multiple brain abscesses: case report of neurobrucellosis. Med Sci Monit 12:CS119–122PubMed
25.
Khalid M, Khalid S, Mittal S, Ahmad U (2012) Intramedullary tubercular abscess with syrinx formation. J Pediatr Neurosci 7:61–63CrossRefPubMed
26.
Koch BL, Moosbrugger EA, Egelhoff JC (2007) Symptomatic spinal epidural collections after lumbar puncture in children. Am J Neuroradiol 28:1811–1816CrossRefPubMed
27.
Lee AC, Lau Y, Li CH, Wong YC, Chiang AK (2007) Intraspinal and intracranial hemorrhage after lumbar puncture. Pediatr Blood Cancer 48:233–237CrossRefPubMed
28.
Levine JF, Hiesiger EM, Whelan MA, Pollock AA, Simbekoff MS, Rahal JJ Jr (1982) Pneumococcal meningitis associated with retroperitoneal abscess. A rare complication of lumbar puncture. JAMA 248:2308–2309CrossRefPubMed
29.
Lin LC, Liao YM, Yang RC (2006) Pneumorrhachis following lumbar puncture: a case report Kaohsiung. J Med Sci 22:39–43
30.
Malik N, Behari S, Ansari MS, Jaiswal AK, Gupta P, Jain M (2011) An intramedullary tuberculous abscess of the conus in a 5-year-old child presenting with urinary dysfunction World. Neurosurg 76(592 e):15–18
31.
McDonald JV, Klump TE (1986) Intraspinal epidermoid tumors caused by lumbar puncture. Arch Neurol 43:936–939CrossRefPubMed
32.
Menezes AH, VanGilder JC (1985) Spinal cord abscess. In: Wilkins RH, Rengachary SS (eds): Neurosurgery New York, McGraw-Hill, pp 1969–1972
33.
Mohindra S, Gupta R, Chhabra R, Gupta SK, Pathak A, Bal AK et al (2008) Infected intraparenchymal dermoids: an underestimated entity. J Child Neurol 23:1011–1016CrossRefPubMed
34.
Mohindra S, Sodhi HS, Aggarwal A (2012) Management problems of intramedullary holocord abscess: an illustration in a pediatric case. Childs Nerv Syst 28:637–640CrossRefPubMed
35.
Morimoto K, Takemoto O, Nakamura H, Takeuchi M (2003) Spinal dermal sinus associated with intramedullary abscess and dermoid. Pediatr Neurosurg 39:225–226CrossRefPubMed
36.
Morrison RE, Brown J, Gooding RS (1980) Spinal cord abscess caused by Listeria monocytogenes. Arch Neurol 37:243–244CrossRefPubMed
37.
Ornek K, Ogurel T (2008) An oculomotor palsy developing immediately after a spinal tap in a 6-year-old child. Paediatr Anaesth 18:1235CrossRefPubMed
38.
38 Park SW, Yoon SH, Cho KH, Shin YS, Ahn YH (2007) Infantile lumbosacral spinal subdural abscess with sacral dermal sinus tract Spine (Phila Pa 1976) 32:E52-55.
39.
Reihsaus E, Waldbaur H, Seeling W (2000) Spinal epidural abscess: a meta-analysis of 915 patients. Neurosurg Rev 23:175–204CrossRefPubMed
40.
Rifaat M, El-Shafei I, Samra K, Sorour O (1973) Intramedullary spinal abscess following spinal puncture. Case report J Neurosurg 38:366–367
41.
41 Shah JR, Joshi V, Patkar D (2007) Dorsal dermal sinus with intramedullary abscess formation Australas Radiol. Suppl:B205-209
42.
Simon JK, Lazareff JA, Diament MJ, Kennedy WA (2003) Intramedullary abscess of the spinal cord in children: a case report and review of the literature. Pediatr Infect Dis J 22:186–192PubMed
43.
Smaoui H, Hariga D, Hajji N, Bouziri A, Ben Jaballah N, Barsaoui S et al (2011) Iatrogenic meningitis after diagnosis lumbar puncture: 3 cases reports in the paediatric Children’s Hospital of Tunis. Bull Soc Pathol Exot 104:10–13CrossRefPubMed
44.
Tacconi L, Arulampalam T, Johnston FG, Thomas DG (1995) Intramedullary spinal cord abscess: case report. Neurosurgery 37:817–819CrossRefPubMed
45.
Tanriverdi T, Kizilkilic O, Hanci M, Kaynar MY, Unalan H, Oz B (2003) Atypical intradural spinal tuberculosis: report of three cases. Spinal Cord 41:403–409CrossRefPubMed
46.
Tsurubuchi T, Matsumura A, Nakai K, Fujita K, Enomoto T, Iwasaki N et al (2002) Reversible holocord edema associated with intramedullary spinal abscess secondary to an infected dermoid cyst. Pediatr Neurosurg 37:282–286CrossRefPubMed
47.
Tufan K, Cekinmez M, Sener L, Erdogan B (2008) Infected lumbar dermoid cyst presenting with tetraparesis secondary to holocord central lesion. J Child Neurol 23:934–937CrossRefPubMed
48.
Yuceer N, Senoglu M, Arda MN (2004) Intramedullary spinal cord abscess in a 4-year old child. Acta Neurochir (Wien) 146:1273–1274CrossRef
Metadata
Title
Intramedullary spinal cord abscess as complication of lumbar puncture: a case-based update
Authors
Paulo Sergio Lucas da Silva
Rafael Duarte de Souza Loduca
Publication date
01-07-2013
Publisher
Springer-Verlag
Published in
Child's Nervous System / Issue 7/2013
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-013-2093-9

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