===== Spinal Cord Infection =====

Infections of the spinal cord and surrounding structures can lead to severe neurological damage and require urgent diagnosis and treatment.

==== 1. Definition ====
Spinal cord infections refer to inflammatory or infectious processes affecting the **spinal cord**, **meninges**, or **epidural/subdural spaces**.

==== 2. Classification by Type ====
  * **Myelitis (intramedullary)** – Inflammation/infection of the spinal cord parenchyma itself  
    _Examples: viral transverse myelitis, post-infectious myelitis_
  * **Spinal Epidural Abscess (SEA)** – Purulent collection in the epidural space, often compressive  
    _Common agents: Staphylococcus aureus, Streptococci_
  * **Spinal Subdural Empyema** – Rare infection between dura and arachnoid
  * **Infectious Arachnoiditis** – Chronic inflammation of arachnoid due to TB, syphilis, or post-surgical infection
  * **Vertebral Osteomyelitis/Discitis** – Infection of vertebral bodies or discs that may spread to the spinal canal

==== 3. Etiology ====
^ Type        ^ Common Pathogens / Causes                    ^
| **Bacterial**   | Staphylococcus aureus, Mycobacterium tuberculosis |
| **Viral**       | Herpes viruses, Enteroviruses, HTLV-1            |
| **Fungal**      | Candida, Aspergillus, Histoplasma                |
| **Parasitic**   | Schistosoma, Cysticercosis                       |
| **Post-surgical / iatrogenic** | Instrumentation, spinal injections |

==== 4. Clinical Features ====
  * Fever, back pain, and **rapidly progressive neurological deficit** (e.g. weakness, sensory level, bladder dysfunction)
  * **Radicular pain** in infectious arachnoiditis
  * Possible **signs of spinal cord compression**

==== 5. Diagnosis ====
  * **MRI with contrast** – Gold standard for evaluating spinal infections
  * **CSF analysis** – In cases of myelitis
  * **Blood cultures** – Identify systemic spread
  * **Biopsy** or aspiration – In abscesses or unclear cases

==== 6. Treatment ====
  * **Empiric IV antibiotics**, then tailored to culture results
    * SEA: Vancomycin + 3rd-gen cephalosporin
  * **Corticosteroids** – Controversial, sometimes used in myelitis
  * **Surgical decompression** if spinal cord compression or abscess
  * **Antivirals or antifungals** as indicated
  * **Antituberculous therapy** for TB-related infections

==== Summary Table ====
^ **Condition**           ^ **Imaging Finding**                 ^ **Treatment**                            ^
| Epidural Abscess        | Rim-enhancing lesion in epidural space | Surgical drainage + IV antibiotics     |
| Transverse Myelitis     | Long segment T2 hyperintensity in cord | Antivirals, corticosteroids            |
| Infectious Arachnoiditis| Clumped nerve roots in thecal sac     | Anti-TB or anti-syphilis therapy       |
| Discitis/Osteomyelitis  | Disc space narrowing + endplate changes | IV antibiotics ± surgery              |

==== Notes ====
  * Delayed treatment can lead to irreversible paraplegia.
  * Always rule out **coexistent infections** (e.g., endocarditis).
  * Close follow-up with **serial MRI** and inflammatory markers is essential.