Rapidly Progressive Impaired Consciousness in Cervical Intramedullary Spinal Cord Abscess: A Case Report

TL;DR

A rare case of a spinal abscess causing rapid loss of consciousness is reported, showing that early surgery and antibiotics can lead to recovery.

Contribution

This case report highlights a rare presentation of cervical spinal cord abscess causing impaired consciousness without intracranial infection.

Findings

A cervical spinal cord abscess can lead to impaired consciousness via brainstem edema without intracranial infection.

Emergency surgery and antibiotic treatment can result in full recovery and no recurrence over ten years.

No obvious source of infection was identified despite extensive investigation.

Abstract

Intramedullary spinal cord abscesses rarely cause impaired consciousness without intracranial infection. We report the case of a 65-year-old woman who presented with neck pain and right upper limb weakness. She developed rapidly progressive impaired consciousness within three days of admission. Initial magnetic resonance imaging revealed a right-sided intramedullary lesion at C4-C5 with surrounding edema extending to the brainstem. Brain imaging showed no abnormalities. An initial diagnosis of a spinal cord tumor was made. Follow-up imaging demonstrated lesion expansion with ring enhancement. The patient subsequently developed impaired consciousness and quadriplegia. Emergency surgery revealed and drained a spinal cord abscess, with cultures growing α-hemolytic Streptococcus. The patient’s consciousness improved quickly after surgery. Previously undiagnosed type 2 diabetes was identified during admission. Despite extensive investigation, no obvious source of infection was found. Antibiotic therapy with ampicillin was continued for one month. Imaging at two months showed complete resolution of the abscess. The patient regained independent walking ability after rehabilitation, with only slight residual right arm weakness. No recurrence was observed during ten years of follow-up. This case demonstrates that a cervical spinal cord abscess can cause impaired consciousness through brainstem edema without intracranial infection. Early surgical intervention combined with appropriate antibiotics may lead to favorable outcomes.

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