J Korean Neurosurg Soc.  2015 Mar;57(3):225-228. 10.3340/jkns.2015.57.3.225.

Catastrophic Intramedullary Abscess Caused by a Missed Congenital Dermal Sinus

• Dho YS
• Kim SK
• Wang KC
• Phi JH

• KMID: 2191228
• DOI: http://doi.org/10.3340/jkns.2015.57.3.225

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.

Keyword

Congenital dermal sinus; Intramedullary abscess; Diagnosis

MeSH Terms

Abscess*
Diagnosis
Female
Fever
Humans
Infant
Neural Tube Defects
Quadriplegia
Skin
Spina Bifida Occulta*

Figure

• 

  Fig. 1 Photographs of the sacral skin dimple. A : The dimple (arrow) was located far above the gluteal folds, approximately 6 cm away from anus. B : Whitish thick discharges (arrow) were squeezed out from the dimple with manual pressure.

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  Fig. 2 A and B : Spinal MRI shows a diffuse swelling of the spinal cord and a high signal intensity up to the medulla oblongata (A) and a low-lying conus to the S3 level (B). C : On gadolinium-enhanced image, dilatation of the central canal and multiple intramedullary rim-enhancing cysts are observed. D : A dermal sinus tract (arrow) is seen from the skin dimple to a bony defect at the S3 level.

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  Fig. 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.

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