Holocord intramedullary abscess: an unusual case with review of literature

Study design: A rare case of a holocord intramedullary abscess with review of literature. Objectives: Summary of clinical presentation, radiology, microbiology, etiology and management of intramedullary spinal cord abscess. Abscess involving the entire spinal cord is extremely rare and awareness of such an event could avoid delay in evacuation of the absess. Methods: The incidence, clinical presentation, radiological investigations, treatment and etiology of intramedullary spinal cord abscess in 100 consecutive cases are discussed. Results: Intramedullary spinal cord abscesses are rare. Presently, only five cases of holocord intramedullary abscess are described. In our analysis of 100 cases of intramedullary abscess, a male preponderance was found. The first and the third decades were the most common age groups. Prognosis is poor if treatment is delayed. Contrast-enhanced MRI is the ideal investigation for diagnosis. Prompt surgical drainage of the abscess with appropriate antibiotic therapy is mandatory since the natural course of the disease has a very unfavourable outcome. Staphylococcus and Streptococcus were the most common causative organisms. Conclusion: Intramedullary spinal cord abscess along the entire length of spinal cord is rare. A thorough history with precise clinical localisation, a high index of suspicion, contrast-enhanced MRI at appropriate level and prompt surgical drainage with appropriate antibiotic therapy are key to the eventual outcome and prognosis.