Tuberculous rhombencephalitis presenting with pseudo-spinal pattern of sensory loss

Abstract

Tuberculous rhombencephalitis is an uncommon presentation of intracranial tuberculosis. A 57 year old female, presented with central positional vertigo and features of left 5 and 7 cranial nerve palsy, with a sensory dermatomal level to pain and temperature and diminished vibration sense on left side. On evaluation, was found to have multiple discrete and conglomerate ring enhancing lesions in pons with normal MRI of spine. After extensive evaluation with Magnetic Resonance Spectroscopy, Cerebrospinal fluid and blood investigations and Mantoux test, possible tuberculosis rhombencephalitis was considered and was started on antitubercular treatment, to which she responded well. Our patient had an atypical presentation with sensory level in trunk, which has not been reported in literature. Hence we describe this case and review the neuroanatomical substrates involved. A high index of suspicion is always needed, while dealing with atypical presentations.