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The affected disc space is usually narrowed and demonstrates low signal intensity on T2-weighted MR sequences. The first radiographic sign of infection is irregularity of the vertebral body endplates. Worldwide, organisms such as TB are not uncommon etiologies. Staphylococcus aureus represents the most common etiologic organism. Although infection can occur at any level, the midlumbar spine is most often affected. Contrast-enhanced MRI is the study of choice and should be performed without delay in suspected cases ( Fig. Rare related hemorrhages can at times be better elucidated with use of gradient echo sequences.ĭisc space infection often coexists with vertebral osteomyelitis in children as a result of hematogenous spread through capillary tufts in vertebral body endplates and vascular channels of immature intervertebral disc spaces. Like infections elsewhere, increase in cord caliber often occurs as a result of an increase in water content and edema. In general, abnormalities present with hyperintensity on fluid-sensitive (T2-weighted) sequences and with variable enhancement on postgadolinium T1-weighted sequences. Magnetic resonance imaging (MRI) is the gold standard examination for the evaluation of spinal cord infection. Inflammation related to infection and resultant neurologic deficit are frequently how spinal cord infections manifest, prompting imaging for diagnostic answers. Jiraporn Laothamatas of Mahidol University, Bangkok, Thailand.) Sagittal ( A) and axial ( B) postcontrast T1-weighted images of the thoracic spine demonstrate enhancing nodules ( arrows in A and B) within the spinal cord proper as a result of a parasitic infection.
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It is endemic in Southeast Asia and virtually unknown in North America, other than in persons with infections that are acquired abroad.įigure 44-5 A 17-year-old boy from Thailand with gnathostomiasis. 44-5) is caused by the nematode Gnathostoma spinigerum, which is acquired by ingesting contaminated fish or meat and presents clinically with myeloradiculitis. It occurs after ingestion of uncooked pork infected with Taenia solium and is most prevalent in South America and Southeast Asia. 44-4) is the most common parasitic infection encountered within the spinal cord. TB is most prevalent in India, but it is also widespread in Africa and in Southeast Asia. 44-3) and manifests as an intramedullary tuberculoma, most often seen in patients with acquired immunodeficiency syndrome or other types of immunocompromise. Tuberculosis (TB) of the spinal cord usually occurs in the thoracic region in children ( Fig. 44-2), with cases initially appearing along the east coast of the United States, has since been discovered nationwide and also has emerged as a more recent spinal cord infectious agent. 44-1) caused by a Borrelia burgdorferi infected tick bite has emerged as a cause of spinal cord infection, especially in the Northeastern United States. Direct bacterial infectious inoculation may occur as a result of trauma, instrumentation, or via a preexisting congenital sinus tract or area of spinal dysraphism (i.e., a meningocele). Etiologies include direct and indirect (hematogenous) inoculation by bacterial, viral, parasitic, and fungal agents. Spinal infections in children are uncommon.