Virtanen, Piiamaria S.Jimenez, Med Jimson D.Horak, V. JaneDesai, Virendra R.Manaloor, John J.Raskin, Jeffrey S.2024-03-282024-03-282023-01-23Virtanen PS, Jimenez MJD, Horak VJ, Desai VR, Manaloor JJ, Raskin JS. Concomitant brain abscess and spinal cord abscess in an immunocompetent teenage male: illustrative case. J Neurosurg Case Lessons. 2023;5(4):CASE22458. Published 2023 Jan 23. doi:10.3171/CASE22458https://hdl.handle.net/1805/39584Background: Multiple bilateral brain abscesses occur rarely in immunocompetent patients. Hematogenous spread to the central nervous system (CNS) allows suppuration and abscess formation in the privileged immune environment of the CNS; hematogenous spread to the spinal cord is extremely rare and the combination of multifocal brain abscesses and intramedullary abscesses has not been reported. This report presents a rare presentation and diagrams a treatment algorithm involving iterative minimal access surgeries and prolonged medical management. Observations: The authors present a case of an 18-year-old male with numerous multifocal and bilateral intraparenchymal abscesses and a medically resistant C5 intramedullary spinal cord abscess. The symptomatic patient had a left oculomotor palsy and left hemiparesis, ultimately undergoing ultrasound-guided aspiration of abscesses in the left frontal and left cerebral peduncle. Following transient motor improvement, he evolved tetraparesis prompting spinal cord imaging and emergent ultrasound-guided needle aspiration of an occult C5 intramedullary spinal cord abscess. The patient received appropriate medical therapy, completed inpatient rehabilitation, and made a full recovery. Lessons: Needle- and ultrasound-guided catheter drainage of CNS abscesses should be considered for symptomatic lesions. Following the neurological examination closely is extremely important; if the expected neurological improvement is delayed or regresses, then expanded imaging is warranted.en-USAttribution-NonCommercial-NoDerivatives 4.0 InternationalBrain abscessSpinal cordSurgical managementBrainstemS. intermediusArticle