Acute quadriplegia in a 53 yr old M with bacterial pericardi
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Case Summary
A 53-year-old male presented with fevers and acute onset, progressive weakness involving all four extremities over the course of three days. His past medical history was significant for an episode of treated Streptococcus (unspeciated) pericarditis, diagnosed nine months prior to current presentation. No recent history of trauma, IV drug abuse, or spinal surgery was reported.

On admission, the patient was afebrile. Neurologic evaluation revealed normal mental status with intact cranial nerves. Strength was completely absent in both lower extremities, though 3/5 in both upper extremities, with hypoesthesia below the nipple line. No meningeal signs were reported. Admission laboratory values showed an elevated white blood count of 21.1 K/mcL with slightly elevated C-reactive protein. Cerebrospinal fluid and blood cultures yielded no growth. A transthoracic echocardiogram revealed normal left ventricular size and function, without evidence of vegetations or pericardial effusion.

Imaging Findings
Magnetic resonance imaging (MRI) of the thoracic spine demonstrated heterogeneous STIR-weighted signal abnormality involving the T1 to T3 levels with extensive surrounding edema. T1-weighted imaging demonstrated corresponding hypointense signal abnormality. Post-contrast imaging revealed a thin rim of enhancement surrounding the lesion. There was no evidence of spondylodiscitis or epidural abscess. Given the rapid clinical presentation, these findings raised the suspicion for an intramedullary spinal cord abscess (ISCA).

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