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Catastrophic intramedullary abscess caused by a missed congenital dermal sinus.

Dho YS, Kim SK, Wang KC, Phi JH - J Korean Neurosurg Soc (2015)

Bottom Line: A 12-month-old girl presented with fever and ascending quadriparesis.She had a midline skin dimple in the upper sacral area that had been discovered in her neonatal period.Overlooking CDS or misdiagnosing it as benign sacrococcygeal dimple may lead to catastrophic infection and cause serious neurological deficits.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT
Congenital dermal sinus (CDS) is a type of occult spinal dysraphism characterized by a midline skin dimple. A 12-month-old girl presented with fever and ascending quadriparesis. She had a midline skin dimple in the upper sacral area that had been discovered in her neonatal period. Imaging studies revealed a holocord intramedullary abscess and CDS. Overlooking CDS or misdiagnosing it as benign sacrococcygeal dimple may lead to catastrophic infection and cause serious neurological deficits. Therefore, further imaging work-up or consultation with a pediatric neurosurgeon is recommended following discovery of any atypical-looking dimples in the midline.

No MeSH data available.


Related in: MedlinePlus

A and B : Spinal MRI shows a diffuse swelling of the spinal cord and a high signal intensity up to the medulla oblongata (A) and a low-lying conus to the S3 level (B). C : On gadolinium-enhanced image, dilatation of the central canal and multiple intramedullary rim-enhancing cysts are observed. D : A dermal sinus tract (arrow) is seen from the skin dimple to a bony defect at the S3 level.
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Figure 2: A and B : Spinal MRI shows a diffuse swelling of the spinal cord and a high signal intensity up to the medulla oblongata (A) and a low-lying conus to the S3 level (B). C : On gadolinium-enhanced image, dilatation of the central canal and multiple intramedullary rim-enhancing cysts are observed. D : A dermal sinus tract (arrow) is seen from the skin dimple to a bony defect at the S3 level.

Mentions: Spinal magnetic resonance imaging (MRI) was immediately obtained (Fig. 2). The MRI revealed diffuse high signal intensity along the spinal cord up to the medulla oblongata. There was a low-lying conus down to the S3 level. An enlarged central canal and thick gadolinium-enhancement of the lining up to the T1 level was observed. There were multiple cystic dilatations with rim enhancement in the lumbosacral cord. A dermal sinus tract ran obliquely upward from the conus at the S3 level to the skin. An infected CDS with massive holocord pyomyelia was diagnosed.


Catastrophic intramedullary abscess caused by a missed congenital dermal sinus.

Dho YS, Kim SK, Wang KC, Phi JH - J Korean Neurosurg Soc (2015)

A and B : Spinal MRI shows a diffuse swelling of the spinal cord and a high signal intensity up to the medulla oblongata (A) and a low-lying conus to the S3 level (B). C : On gadolinium-enhanced image, dilatation of the central canal and multiple intramedullary rim-enhancing cysts are observed. D : A dermal sinus tract (arrow) is seen from the skin dimple to a bony defect at the S3 level.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4373056&req=5

Figure 2: A and B : Spinal MRI shows a diffuse swelling of the spinal cord and a high signal intensity up to the medulla oblongata (A) and a low-lying conus to the S3 level (B). C : On gadolinium-enhanced image, dilatation of the central canal and multiple intramedullary rim-enhancing cysts are observed. D : A dermal sinus tract (arrow) is seen from the skin dimple to a bony defect at the S3 level.
Mentions: Spinal magnetic resonance imaging (MRI) was immediately obtained (Fig. 2). The MRI revealed diffuse high signal intensity along the spinal cord up to the medulla oblongata. There was a low-lying conus down to the S3 level. An enlarged central canal and thick gadolinium-enhancement of the lining up to the T1 level was observed. There were multiple cystic dilatations with rim enhancement in the lumbosacral cord. A dermal sinus tract ran obliquely upward from the conus at the S3 level to the skin. An infected CDS with massive holocord pyomyelia was diagnosed.

Bottom Line: A 12-month-old girl presented with fever and ascending quadriparesis.She had a midline skin dimple in the upper sacral area that had been discovered in her neonatal period.Overlooking CDS or misdiagnosing it as benign sacrococcygeal dimple may lead to catastrophic infection and cause serious neurological deficits.

View Article: PubMed Central - PubMed

Affiliation: Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Korea.

ABSTRACT
Congenital dermal sinus (CDS) is a type of occult spinal dysraphism characterized by a midline skin dimple. A 12-month-old girl presented with fever and ascending quadriparesis. She had a midline skin dimple in the upper sacral area that had been discovered in her neonatal period. Imaging studies revealed a holocord intramedullary abscess and CDS. Overlooking CDS or misdiagnosing it as benign sacrococcygeal dimple may lead to catastrophic infection and cause serious neurological deficits. Therefore, further imaging work-up or consultation with a pediatric neurosurgeon is recommended following discovery of any atypical-looking dimples in the midline.

No MeSH data available.


Related in: MedlinePlus