Limits...
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

Intraoperative photographs. A : After dural opening, we observed a thickened spinal cord that was connected to the dermal sinus tract containing multiple dermoid cysts (arrow). B : Green-colored pus was discharged after dorsal midline myelotomy.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4373056&req=5

Figure 3: Intraoperative photographs. A : After dural opening, we observed a thickened spinal cord that was connected to the dermal sinus tract containing multiple dermoid cysts (arrow). B : Green-colored pus was discharged after dorsal midline myelotomy.

Mentions: An emergency operation for abscess evacuation and untethering was performed. The sinus tract was followed from the skin ostium. There were multiple dermoid cysts along the sinus tract entering the dural sac through the fascial and bone defect (Fig. 3). After a multi-level laminectomy, the dural sac was opened and a thickened spinal cord was observed. A dorsal midline myelotomy was made and noxious green-colored pus was discharged from the abscess. The abscess cavity and syrinx were flushed with saline. Finally, the sinus tract was resected just distal to the last root.


Catastrophic intramedullary abscess caused by a missed congenital dermal sinus.

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

Intraoperative photographs. A : After dural opening, we observed a thickened spinal cord that was connected to the dermal sinus tract containing multiple dermoid cysts (arrow). B : Green-colored pus was discharged after dorsal midline myelotomy.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Intraoperative photographs. A : After dural opening, we observed a thickened spinal cord that was connected to the dermal sinus tract containing multiple dermoid cysts (arrow). B : Green-colored pus was discharged after dorsal midline myelotomy.
Mentions: An emergency operation for abscess evacuation and untethering was performed. The sinus tract was followed from the skin ostium. There were multiple dermoid cysts along the sinus tract entering the dural sac through the fascial and bone defect (Fig. 3). After a multi-level laminectomy, the dural sac was opened and a thickened spinal cord was observed. A dorsal midline myelotomy was made and noxious green-colored pus was discharged from the abscess. The abscess cavity and syrinx were flushed with saline. Finally, the sinus tract was resected just distal to the last root.

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