Intra-medullary abscess of the spinal cord at the high cervical level

Intramedullary spinal cord abscess (ISCA) is a rare entity in the central nervous system, especially in patients without meningitis. It is often difficult to promptly establish the diagnosis. In this report, we describe the case of a woman 52 years of age who presented with progressive neck pain that was followed by rapidly worsening quadriparesis. The cervical spine magnetic resonance imaging revealed an ovoid lesion at the level of C2-C4 with a gadolinium contrast ring enhancement. Because ISCA was suspected, we performed surgery to decompress the cervical spinal cord. The bacterial culture of the cystic content revealed the growth of two bacteria, Fusobacterium nucleatum and Peptoniphilus asaccharolyticus, which have rarely been observed. The patient's postoperative course was uneventful and her outcome was excellent on discharge. Antibiotics were prescribed for 6 weeks. We further report the result of a literature review on the management of ISCA. The surgical indications for ISCA are controversial, but early surgery to decompress the spinal cord and confirm bacterial growth is recommended in rapidly worsening cases.