Diagnosis and Treatment of Cauda Equina Arachnoiditis, a Rare Manifestation of Tuberculosis Meningoencephalitis: A Case Report

Abstract

Tuberculous meningoencephalitis (TM) is an acute, progressive form of tuberculosis (TB). The epidemiology, clinical signs, and diagnosis of TB are well established, but several atypical forms of tuberculous spinal arachnoiditis can be easily misdiagnosed. We report a rare case of TM with cauda equina arachnoiditis diagnosed by magnetic resonance imaging and an electrodiagnostic study. A 26-year-old otherwise healthy male patient experienced fever, headache, gait disturbance, and bladder and bowel incontinence. Needle electromyography (EMG) recordings were suggestive of bilateral diffuse lumbar and lumbosacral polyradiculopathy, and the pudendal sensory-evoked potential and bulbocavernosus reflex latencies were prolonged. Lumbar arachnoiditis is a rare clinical condition that warrants a heightened index of suspicion. It has diverse etiologies and symptoms, and it can lead to potentially serious and irreversible disorders. This case illustrates the usefulness of nerve conduction, EMG, and pudendal sensory-evoked potential and bulbocavernosus reflex latency studies in the diagnosis of cauda equina syndrome induced by TB arachnoiditis.