Intramedullary Lesion- Aspetic subdural pyogenic abscess in dorsolumbar spinal cord with conus medularis cystic lesion with syringomelitis: A Case Report

Abstract

Spinal subdural abscess/empyema is uncommon but serious condition with significant morbidity and mortality. Till date very few cases of spinal subdural abscess has been reported. Prognosis of Spinal Subdural Abscess is highly dependent on the timeliness of its diagnosis before neurological deficits develop. Risk factors, presenting symptoms, and characteristic findings on magnetic resonance imaging (MRI) findings should be properly considered and thoroughly evaluated. Symptoms include fever, back pain, and neurological symptoms, but this collection of symptoms is seen in only about 10% of cases. However, most patients complain of severe localized lower back pain. Gadolinium-enhanced MRI is the most sensitive, specific, and beneficial imaging modality for establishing a diagnosis While hematogenous spread of an extra-spinal infection is the most common cause of this condition, a significant number of cases result from iatrogenic mechanisms, including lumbar punctures, epidural injections, and surgery. In few cases there may be no organism isolated as in our case, possible reason being prior usage of antibiotics before surgery. Treatment should include prompt surgical exploration and decompression combined with appropriate prolonged antibiotic treatment with regular follow up and physiotherapy.