Intramedullary spinal cord abscesses (ISCA) are rare infections of the central nervous system that typically affect the thoracic spinal cord. We describe a rare case of cervical ISCA discovered from the aggressive local spread of a cervical osteomyelitis accompanied by meningitis.

A 58-year-old woman with diabetes and hypertension presented to an outside hospital with a two-week history of headaches and progressive neck pain. Computerized tomography (CT) of the cervical spine showed cervical degeneration and spinal stenosis. She was diagnosed with torticollis and discharged home with diazepam.

She re-presented one day later with worsening symptoms. Cerebrospinal fluid analysis from a lumbar puncture was concerning for meningitis and she was started immediately on broad-spectrum antibiotics. However, the patient developed rapidly progressive quadriparesis. An emergent magnetic resonance imaging (MRI) of her cervical spine showed a retropharyngeal abscess, C5-C6 osteomyelitis, and C3-C7 cord edema and compression. She was then transferred to our center for further management.

The patient underwent an emergent C3-C7 decompressive laminectomy and posterior spinal fusion. Blood cultures from the original hospital and surgical cultures grew methicillin sensitive staphylococcus aureus. Her antibiotics were narrowed to oxacillin, but the patient remained persistently encephalopathic and quadriplegic. A repeat MRI of the cervical spine showed edema from the cervico-medullary junction to the T3 level and an ISCA measuring approximately 8.5 x 7.0 x 9 mm that extended to the C7 level. The patient required a tracheostomy and percutaneous endoscopic gastrostomy for a prolonged treatment course, but family reported that this was not consistent with her wishes. She was made comfortable and passed away.

Intramedullary spinal cord abscesses can be associated with poor outcomes such as significant neurologic deficits and death. Early diagnosis and immediate treatment are needed to prevent adverse outcome.