Spinal Intramedullary Tuberculosis

Abstract

Tuberculosis of the central nervous system accounts for approximately 1% of all cases of tuberculosis and 50% of these involve the spine. Intramedullary involvement is rare in tuberculosis. Clinical presentation of spinal intramedullary tuberculosis (SIMT) is similar to intramedullary spinal cord tumor. Here, we report the case of a 49-year-old female with dull aching pain of both upper limbs of 1-week duration. On examination, she had no motor deficits. All the deep tendon reflexes were normal. The plantar responses were flexor bilaterally. Cervical spine imaging favored intramedullary tumor. She had partial relief of symptoms with steroid treatment. Repeat imaging done 1 month later revealed mild interval enlargement of the intramedullary lesions and multiple enlarged mediastinal and hilar nodes. Endoscopic ultrasound-guided fine-needle aspiration cytology of mediastinal nodes was suggestive of granulomatous inflammation. Hence, SIMT was considered as the probable diagnosis. The patient was started on antituberculosis therapy.

Keywords

tuberculosis - spinal - intramedullary - tuberculoma

• References

• 1 Cherian A, Thomas SV. Central nervous system tuberculosis. Afr Health Sci 2011; 11 (01) 116-127
• 2 Jain AK, Dhammi IK. Tuberculosis of the spine: a review. Clin Orthop Relat Res 2007; 460 (460) 39-49
• 3 Sohn S, Jin YJ, Kim KJ, Kim HJ. Long-term sequela of intradural extramedullary tuberculoma in the thoracic dorsal spinal cord: case report and review of the literature. Korean J Spine 2011; 8 (04) 295-299
• 4 Muthukumar N, Venkatesh G, Senthilbabu S, Rajbaskar R. Surgery for intramedullary tuberculoma of the spinal cord: report of 2 cases. Surg Neurol 2006; 66 (01) 69-74 , discussion 74
• 5 Dastur D, Wadia NH. Spinal meningitides with radiculo-myelopathy. 2. Pathology and pathogenesis. J Neurol Sci 1969; 8 (02) 261-297
• 6 Abercrombie J. Pathological and Practical Researches on Disease of the Brain and the Spinal Cord. Edinburg: Waugh and Innes; 1828: 371-372
• 7 Arseni C, Samitca DC. Intraspinal tuberculous granuloma. Brain 1960; 83: 285-292
• 8 Lin SK, Wu T, Wai YY. Intramedullary spinal tuberculomas during treatment of tuberculous meningitis. Clin Neurol Neurosurg 1994; 96 (01) 71-78
• 9 Lin TH. Intramedullary tuberculoma of the spinal cord. J Neurosurg 1960; 17: 497-499
• 10 Chatterjee S. Brain tuberculomas, tubercular meningitis, and post-tubercular hydrocephalus in children. J Pediatr Neurosci 2011; 6 (Suppl. 01) S96-S100
• 11 Dastur HM. A tuberculoma review with some personal experiences. II. Spinal cord and its coverings. Neurol India 1972; 20 (03) 127-131
• 12 Nussbaum ES, Rockswold GL, Bergman TA, Erickson DL, Seljeskog EL. Spinal tuberculosis: a diagnostic and management challenge. J Neurosurg 1995; 83 (02) 243-247
• 13 MacDonnell AH, Baird RW, Bronze MS. Intramedullary tuberculomas of the spinal cord: case report and review. Rev Infect Dis 1990; 12 (03) 432-439
• 14 Torii H, Takahashi T, Shimizu H, Watanabe M, Tominaga T. Intramedullary spinal tuberculoma--case report. Neurol Med Chir (Tokyo) 2004; 44 (05) 266-268
• 15 Devi BI, Chandra S, Mongia S, Chandramouli BA, Sastry KV, Shankar SK. Spinal intramedullary tuberculoma and abscess: a rare cause of paraparesis. Neurol India 2002; 50 (04) 494-496
• 16 Ramdurg SR, Gupta DK, Suri A, Sharma BS, Mahapatra AK. Spinal intramedullary tuberculosis: a series of 15 cases. Clin Neurol Neurosurg 2009; 111 (02) 115-118
• 17 Park DW, Sohn JW, Kim EH. , et al. Outcome and management of spinal tuberculosis according to the severity of disease: a retrospective study of 137 adult patients at Korean teaching hospitals. Spine 2007; 32 (04) E130-E135