Intramedullary Spinal Cord Abscess; Descriptive Review of the Literature (P2.015)
Bibliographic record
Abstract
Background: Intramedullary spinal cord abscess (ISCA) is a potentially devastating infection of the central nervous system. However, little is known about this entity. We characterize clinical, epidemiological and imaging features of spinal cord abscesses. Methods: We performed a comprehensive literature review of reported ISCA and present a case due to Nocardia. Data were identified by searches of papers published on Embase, Medline, Cinahl and EMB databases, spanning the years 1830-2014, using key words “spinal cord”, “intramedullary”, “abscesses”, “infection”. An “abscess” had to be confirmed by imaging, culture from pyogenic debris/cerebrospinal fluid or intraoperatively. Results: We identified 197 cases of ISCA. We found a striking male predominance (71[percnt]). Almost half (44[percnt]) had acute presentations (0-7 days). Most common risk factors were dermal sinuses (30[percnt]; 54[percnt] under 12 yo), concomitant systemic infection (31[percnt]), and immunocompromised states (13[percnt]). The most common microorganisms were Staphyloccocus and Streptococcus, followed by polymicrobial infections and Mycobacterium Tuberculosis. On imaging, majority of abscesses showed multiple spinal segments extension (90[percnt]), gadolinium ring enhancement (68[percnt]), and diffusion restriction (100[percnt]; n=3). CSF analysis was characterized by leukocytosis, proteinorachia (79[percnt]) and hypoglychoracchia (64[percnt]). Most patients were treated by tandem surgery and antibiotics (63[percnt]). Of the 107 outcomes reported, 30[percnt] fully recovered and 4[percnt] died during course of illness. Conclusion: ISCA are rare and associated with poor outcomes. Rapid diagnosis is paramount to minimize morbidity. Clues to diagnosis include predisposed host, pyogenic CSF, and gadolinium ring enhancement with diffusion restriction. Optimal treatment remains undefined, however combined surgical drainage with appropriate antimicrobials appears most successful.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.017 | 0.019 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".