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Spinal intramedullary abscess

Spinal dysraphism has a varied presentation varying from occult and asymptomatic to obvious like trichosis, lipoma and dermal sinus. We present a case of 8 year old boy who presented with recurrent episodes of meningitis and paraplegia of few days duration alongwith fever in the last episode. On examination, he had a small patch of cutaneous discoloration over the dorsal spine in the midline with a small punctum and fluid discharge. (Figure 1,2). MRI scan showed a large intramedullary abscess and a dermal sinus tract (Figure 3). Exploration was done, tract followed upto the dura (Figure 4) and dorsal laminotomy done. Drainage of the intramedullary abscess was done under microscope. The tract was excised alongwith a rim of dura and duraplasty done with autologous fascial patch. Pus was sent for culture sensitivity and antibiotics started accordingly.
Post-operatively, the child remained paraplegic with no significant neurological recovery.
Aids used: Microscope, Neurosurgical drill

Figure 1: Intramedullary mass lesion with significant edema

Figure 2: Intramedullary mass with peripheral enhancement

Figure 3: Discoloured skin patch with small bead of pus in midline