Concomitant brain abscess and spinal cord abscess in an immunocompetent teenage male: illustrative case

Jeffrey S. Raskin*, Piiamaria S. Virtanen, Med Jimson D. Jimenez, V. Jane Horak, Virendra R. Desai, John J. Manaloor

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


BACKGROUND Multiple bilateral brain abscesses occur rarely in immunocompetent patients. Hematogenous spread to the central nervous system (CNS) allows suppuration and abscess formation in the privileged immune environment of the CNS; hematogenous spread to the spinal cord is extremely rare and the combination of multifocal brain abscesses and intramedullary abscesses has not been reported. This report presents a rare presentation and diagrams a treatment algorithm involving iterative minimal access surgeries and prolonged medical management. OBSERVATIONS The authors present a case of an 18-year-old male with numerous multifocal and bilateral intraparenchymal abscesses and a medically resistant C5 intramedullary spinal cord abscess. The symptomatic patient had a left oculomotor palsy and left hemiparesis, ultimately undergoing ultrasound-guided aspiration of abscesses in the left frontal and left cerebral peduncle. Following transient motor improvement, he evolved tetraparesis prompting spinal cord imaging and emergent ultrasound-guided needle aspiration of an occult C5 intramedullary spinal cord abscess. The patient received appropriate medical therapy, completed inpatient rehabilitation, and made a full recovery. LESSONS Needle- and ultrasound-guided catheter drainage of CNS abscesses should be considered for symptomatic lesions. Following the neurological examination closely is extremely important; if the expected neurological improvement is delayed or regresses, then expanded imaging is warranted.

Original languageEnglish (US)
Article numberCASE22458
JournalJournal of Neurosurgery: Case Lessons
Issue number4
StatePublished - Jan 2023


  • S. intermedius
  • brain abscess
  • brainstem
  • spinal cord
  • surgical management

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery


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