Intramedullary Spinal Cord Abscess Management: Case Series, Operative Video, and Systematic Review.

BACKGROUND: Intramedullary spinal cord abscess (ISCA) is an extremely rare disease, which has had fewer than 250 reported cases since its initial description in 1830. The condition is limited to level V evidence, limiting the ability for surgeons to characterize and treat it. OBJECTIVE: To report the cases of 2 patients with ISCA and their surgical management: a 59-year-old woman who presented with progressive right hemiparesis and a 69-old man who presented with acute gait instability and significant bilateral shoulder pain. In addition, to report findings from a systematic literature review and associated logistic regression analysis. METHODS: A MEDLINE and Embase search was conducted using the keywords "intramedullary," "spinal cord," "abscess," and "tuberculoma" and the results were screened for case reports. A logistic regression model was fit 100 times on data to retrieve predictor odds ratios. RESULTS: Two hundred case reports of ISCA were identified between 1965 and 2022. Logistic regression determined that the only variables of significance were age (P < 0.01) and antibiotics (P < 0.05). CONCLUSIONS: Treatment of ISCAs has significantly improved over the years. However, ISCAs are still poorly understood. Our recommendations can be used to guide diagnosis and treatment.

Stercoral Perforation in the Setting of Chronic Antipsychotic Use: A Case Report.

Stercoral perforation is a rare form of colonic perforation with limited reports in the literature, accounting for less than 140 documented cases. This complication occurs due to increased intraluminal pressure created by fecal impaction, ultimately causing colonic ulceration and necrosis. It is most often seen in elderly or debilitated patients with chronic constipation. The long-term use of drugs or medications with side effects of chronic constipation such as opioids, antispasmodics, tricyclic antidepressants, and calcium channel blockers have been implicated in these cases. Here we present a case of stercoral perforation in a patient with short-term opioid use following an orthopedic procedure, but more likely complicated by long-term use of antipsychotics and antidepressants.

Management of Warfarin-Induced Adrenal Adenoma Hemorrhage in the Setting of a History of Pulmonary Embolism.

Adrenal hemorrhage (AH) is associated with trauma, acute stress, sepsis, coagulopathy, pregnancy, neonatal stress, and underlying adrenal masses, which can include metastases, pheochromocytomas, adrenocortical cancers, or hematomas. However, the literature on nontraumatic AH secondary to an adenoma in the setting of chronic anticoagulation is limited. We present a case report of a patient found to have AH from an incidental adrenal adenoma associated with the use of warfarin in the setting of a recent history of pulmonary embolism requiring anticoagulation. In a patient who presents with AH while on anticoagulation, initial management should include reversal of coagulopathy, supportive care with serial hematocrits and blood transfusions as necessary, and biochemical workup to assess for functional tumors. However, aggressive surgical management with adrenalectomy should ideally follow for those patients who will require long-term anticoagulation to minimize future risk for rebleeding.