{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,9,16]],"date-time":"2024-09-16T16:43:39Z","timestamp":1726505019073},"reference-count":15,"publisher":"California Digital Library (CDL)","issue":"2","license":[{"start":{"date-parts":[[2020,4,23]],"date-time":"2020-04-23T00:00:00Z","timestamp":1587600000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Introduction: Central cord syndrome (CCS) is a clinical syndrome of motor weakness and sensory changes. While CCS is most often associated with traumatic events. There have been few documented cases being caused by abscesses resulting from osteomyelitis.\n\nCase Report: A 56-year-old male presented to a regional trauma center complaining of excruciating neck and bilateral upper extremity pain. Computed tomography of the cervical and thoracic regions revealed severe discitis and osteomyelitis of the fourth and fifth cervical (C4-C5) with near-complete destruction of the C4 vertebral body, as well as anterolisthesis of C4 on C5 causing compression of the central canal. Empiric intravenous (IV) antibiotic therapy with ampicillin\/sulbactam and vancomycin was initiated, and drainage of the abscess was scheduled. After the patient refused surgery, he was planned to be transferred to a skilled nursing facility to receive a six-week course of IV vancomycin therapy. A month later, patient returned to emergency department with the same complaint due to non-compliance with antibiotic therapy.\n\nDiscussion: Delayed diagnosis and treatment of osteomyelitis can result in devastating neurological sequelae, and literature supports immediate surgical debridement. Although past evidence has suggested surgical intervention in similar patients with presence of abscesses, this case may suggest that antibiotic treatment may be an alternative approach to the management of CCS due to an infectious etiology. However, the patient had been non-compliant with medication, so it is unknown whether there was definite resolution of the condition.\n\nConclusion: In patients presenting with non-traumatic central cord syndrome, it is vital to identify risk factors for infection in a thoroughly obtained patient history, as well as to maintain a low threshold for diagnostic imaging.<\/jats:p>","DOI":"10.5811\/cpcem.2019.8.44201","type":"journal-article","created":{"date-parts":[[2020,5,5]],"date-time":"2020-05-05T22:23:58Z","timestamp":1588717438000},"page":"267-271","source":"Crossref","is-referenced-by-count":1,"title":["Subacute Presentation of Central Cord Syndrome Resulting from Vertebral Osteomyelitis and Discitis: A Case Report"],"prefix":"10.5811","volume":"4","author":[{"given":"Thomas","family":"Dang","sequence":"first","affiliation":[{"name":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fanglong","family":"Dong","sequence":"additional","affiliation":[{"name":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Greg","family":"Fenati","sequence":"additional","affiliation":[{"name":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California; California University of Science and Medicine, Department of Emergency Medicine, San Bernardino, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massoud","family":"Rabiei","sequence":"additional","affiliation":[{"name":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melinda","family":"Cerda","sequence":"additional","affiliation":[{"name":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Neeki","sequence":"additional","affiliation":[{"name":"Arrowhead Regional Medical Center, Department of Emergency Medicine, Colton, California; California University of Science and Medicine, Department of Emergency Medicine, San Bernardino, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"29705","published-online":{"date-parts":[[2020,4,23]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Harrop JS, Sharan A, Ratliff J. Central cord injury: pathophysiology, management, and outcomes. Spine J. 2006;6(6 Supplement):S198-206.","DOI":"10.1016\/j.spinee.2006.04.006"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Schneider RC, Thompson JM, Bebin J. The syndrome of acute central cervical spinal cord injury. J Neurol Neurosurg Psychiatry. 1958;21(3):216-27.","DOI":"10.1136\/jnnp.21.3.216"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Schimmer RC, Jeanneret C, Nunley PD, et al. Osteomyelitis of the cervical spine: a potentially dramatic disease. Clin Spine Surg. 2002;15(2):110.","DOI":"10.1097\/00024720-200204000-00004"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Dhandapani S, Karthigeyan M, Sahoo SK, et al. Tectal glioma presenting with clinical triad of obesity, amenorrhea and central cord syndrome with radiological pentad of hydrocephalus, empty sella, suprapineal diverticula, Chiari and syrinx. Childs Nerv Syst. 2017;33(2):385-7.","DOI":"10.1007\/s00381-016-3266-0"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Schneider RC, Cherry G, Pantek H. The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine. J Neurosurg. 1954;11(6):546-77.","DOI":"10.3171\/jns.1954.11.6.0546"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"McKinley W, Santos K, Meade M, et al. Incidence and outcomes of spinal cord injury clinical syndromes. J Spinal Cord Med. 2007;30(3):215-24.","DOI":"10.1080\/10790268.2007.11753929"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Nowak DD, Lee JK, Gelb DE, et al. Central cord syndrome. J Am Acad Orthop Surg. 2009;17(12):756-65.","DOI":"10.5435\/00124635-200912000-00004"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Stevenson CM, Dargan DP, Warnock J, et al. Traumatic central cord syndrome: neurological and functional outcome at 3 years. Spinal Cord. 2016;54(11):1010-5.","DOI":"10.1038\/sc.2016.34"},{"key":"ref8","unstructured":"Akhondi H and Baker MB. Epidural abscess. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2019."},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Stricsek G, Iorio J, Mosley Y, et al. Etiology and surgical management of cervical spinal epidural abscess (SEA): a systematic review. Glob Spine J. 2018;8(4 Suppl):59S-67S.","DOI":"10.1177\/2192568218772048"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Trombly R and Guest JD. Acute central cord syndrome arising from a cervical epidural abscess: case report. Neurosurgery. 2007;61(2):E424.","DOI":"10.1227\/01.neu.0000255515.12085.60"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Al-Hourani K, Al-Aref R, Mesfin A. Upper cervical epidural abscess in clinical practice: diagnosis and management. Glob Spine J. 2016;06(04):383-93.","DOI":"10.1055\/s-0035-1565260"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Sebben AL, Graells XS, Benato ML, et al. High cervical spine spondylodiscitis management and literature review. Rev Assoc M\u00e9dica Bras. 2017;63(1):18-20.","DOI":"10.1590\/1806-9282.63.01.18"},{"key":"ref13","unstructured":"Chao D and Nanda A. Spinal epidural abscess: a diagnostic challenge. Am Fam Physician. 2002;65(7):1341."},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Mackenzie A, Laing R, Smith C, et al. Spinal epidural abscess: the importance of early diagnosis and treatment. J Neurol Neurosurg Psychiatry. 1998;65(2):209-12.","DOI":"10.1136\/jnnp.65.2.209"}],"container-title":["Clinical Practice and Cases in Emergency Medicine"],"original-title":[],"deposited":{"date-parts":[[2020,7,20]],"date-time":"2020-07-20T20:41:34Z","timestamp":1595277694000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/76g6892z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,23]]},"references-count":15,"issue-title":["Clinical Practice and Cases in Emergency Medicine"],"journal-issue":{"issue":"2","published-online":{"date-parts":[[2020,4,1]]}},"URL":"https:\/\/doi.org\/10.5811\/cpcem.2019.8.44201","relation":{},"ISSN":["2474-252X","2474-252X"],"issn-type":[{"type":"electronic","value":"2474-252X"},{"type":"print","value":"2474-252X"}],"subject":[],"published":{"date-parts":[[2020,4,23]]}}}