case_images: PMC10494933_01
case_images: (A) MRI T2-weighted image showed hyperintensity of the lesion on the ventral side of the spinal cord in the C2-C6 spinal canal. Also saw C5/6 intervertebral disc herniation and the corresponding dura and spinal cord were compressed. (B) Axial T2-weighted image showed an annular high signal lesion in the anterior part of the spinal cord within the spinal canal of C2, and spinal cord compression at the C2. (C) T2-weighted image showed hyperintensity of lesions ventral to the spinal cord in the T2-T8 spinal canal, with corresponding levels of spinal cord compression degeneration. (D) Axial T2-weighted image showed annular high signal lesion in the right anterior part of the spinal cord within the spinal canal of T7 accompanied by nerve root and spinal cord compression. (E) T1-enhanced image showed disc bulging in L3/4, L4/5 and L5/S1 with annular enhancement of the lesion ventral to the spinal cord in the L4-S1 spinal canal with spinal cord compression at the corresponding level, but no significant internal enhancement. (F) Axial T1-enhanced image showed a large range of irregular non-enhanced areas in the soft tissue of the right posterior side of the at the L5 level, and a ring-enhancing lesion in the right posterior part of the intradural sac with no obvious internal enhancement.
case_images: fneur-14-1237007-g001.jpg
case_images: PMC10494933_01_fneur-14-1237007-g001.jpg
case_images: fig1
case_images: Although a fluoroscopic-guided lumbar puncture was unsuccessful, an intravenous gadolinium-enhanced magnetic resonance imaging (MRI) revealed an abnormal signal shadow ventral to the spinal canal in the cervicothoracic segment and dorsal to T12-S1 level (Figure 1).
case_images: At 2-month follow-up, sagittal T1-weighted (A) and T2-weighted image (B) and showed the lumbar disc herniation was still present, and the epidural space in the posterior lumbar and anterior sacrococcygeal segments was wider than before, and the enhancement of the dural sac improved after enhancement compared with before. Axial T1-enhanced image (C) showed the previously large range of irregular non-enhanced areas has decreased compared to Figure 1F.
case_images: fneur-14-1237007-g002.jpg
case_images: PMC10494933_01_fneur-14-1237007-g002.jpg
case_images: fig2
case_images: At this time, a repeat MRI showed a significant reduction in the holospinal abscess, particularly in the upper lumbar segment (Figure 2).
case_images: At 1.5-year follow-up, Axial T1-enhanced image of the cervical (A), thoracic (B), and lumbar (C) segments demonstrated that the epidural abscess was almost completely absorbed, and the epidural space now shows normal signal intensity, with a largely improved corresponding spinal cord compression.
case_images: fneur-14-1237007-g003.jpg
case_images: PMC10494933_01_fneur-14-1237007-g003.jpg
case_images: fig3
case_images: At the 1.5-year follow-up, a repeat MRI revealed complete resolution of the epidural abscess (Figure 3), and the patient's muscle strength returned to grade 5 in the extremities.