Rapidly Progressive Impaired Consciousness in Cervical Intramedullary Spinal Cord Abscess: A Case Report.

Intramedullary spinal cord abscesses rarely cause impaired consciousness without intracranial infection. We report the case of a 65-year-old woman who presented with neck pain and right upper limb weakness. She developed rapidly progressive impaired consciousness within three days of admission. Initial magnetic resonance imaging revealed a right-sided intramedullary lesion at C4-C5 with surrounding edema extending to the brainstem. Brain imaging showed no abnormalities. An initial diagnosis of a spinal cord tumor was made. Follow-up imaging demonstrated lesion expansion with ring enhancement. The patient subsequently developed impaired consciousness and quadriplegia. Emergency surgery revealed and drained a spinal cord abscess, with cultures growing α-hemolytic Streptococcus. The patient's consciousness improved quickly after surgery. Previously undiagnosed type 2 diabetes was identified during admission. Despite extensive investigation, no obvious source of infection was found. Antibiotic therapy with ampicillin was continued for one month. Imaging at two months showed complete resolution of the abscess. The patient regained independent walking ability after rehabilitation, with only slight residual right arm weakness. No recurrence was observed during ten years of follow-up. This case demonstrates that a cervical spinal cord abscess can cause impaired consciousness through brainstem edema without intracranial infection. Early surgical intervention combined with appropriate antibiotics may lead to favorable outcomes.