38 UMN
Spinal empyema
INTRODUCTION
The diagnosis of meningomyelitis is made by:
• CSF sample: increase the diagnostic yield by sampling both cranial and caudal to the localized lesion. Pleocytosis is found in the majority of cases. Tissue inflammation occurs to some degree in other conditions such as compression, infarction, and neoplasia. The general trend is that inflammatory CNS disease has greater pleocytosis than other conditions. Variation prevents this being a cast iron rule.
• MRI: may be normal. Contrast enhancement of parenchyma and/or the meninges is highly suggestive of the condition. The cord may be swollen.
• Myelogram: thought to be contraindicated in inflammatory disease because of the risk of contrast agent worsening the inflammation. Contraindicated in known inflammatory CNS disease as it adds nothing to the diagnosis or the treatment. It is used in an emergency only if the chief differential is a suspected extradural lesion requiring surgery. May be normal or show an intramedullary pattern.
• Serology: positive titres indicate exposure to an organism but do not necessarily indicate the presence or absence of clinical disease caused by the organism.
