Intramedullary Tuberculoma Research Articles

Spinal Adhesive Arachnoiditis Following Surgical Treatment for an Intramedullary Tuberculoma of the Conus Medullaris: A Case Report from Western Mexico

Objectives: Describe a rare case of intramedullary tuberculoma (IMT) complicated by chronic adhesive arachnoiditis (CAA). Presentation of Case: A 19-year-old woman presented with complaints of weight loss, progressive weakness of both lower limbs, and urinary retention. Neurological examination corroborated the motor dysfunction of the lower limbs, associated with sensory disturbances. Magnetic resonance imaging (MRI) detected a ring-enhancing intramedullary mass that expanded the conus medullaris. A provisional diagnosis of neoplastic origin lesion was made and the patient received complete resection of the mass. Histopathology was consistent with tuberculoma. 8 months after beginning postoperative antituberculous therapy, neurological symptoms worsened and follow-up MRI showed a distorted spinal cord with arachnoid cysts and septations, findings that corresponded to CAA. Despite a new surgical intervention, the patient remained with lasting disability. Discussion: IMT is an uncommon presentation of spine tuberculosis. The clinical manifestations mimic those of any space-occupying lesion (SOL), and are dependent on the location in the spine, thus a differential diagnosis with neoplastic, inflammatory, and other granulomatous lesions is required. Being IMT an encapsulated lesion, it is unexpected that the inflammatory response extends to pia-arachnoid layers conducting to complications, such as CAA. The association between IMT and CAA must be recognized, since it undermines the outcomes of therapeutical interventions. Conclusion: The diagnosis of IMT complicated by CAA is challenging due to its low frequency. Therefore, this report emphasizes the importance of recognizing the clinical and radiological features of this association to allow an early diagnosis, and facilitate the selection of therapeutic interventions.

21 cm long intra-medullary tuberculoma of dorsal spinal cord

Intramedullary tuberculoma (IMT) is a rare form of spinal tuberculosis. The incidence of this disease is 01-02/100,000 patients (1). Occurs by hematogenous dissemination from focus elsewhere in the body. Magnetic resonance imaging (MRI) is helpful for diagnosing IMT at an early stage and it is also very useful in follow-up. CSF PCR studies are confirmatory. Histopathology is the Gold Standard. AKT drug therapy is the mainstay of treatment for IMT, with surgery indicated in select patients. Here, we describe a female patient with long-segment dorsal intramedullary tuberculoma with compressive myelopathy treated with surgery and put on AKT who improved clinically.

MRI findings of spinal intramedullary tuberculoma

MRI findings of spinal intramedullary tuberculoma

Magnetic Resonance Imaging Findings of Intraspinal Tuberculoma in Children.

Background and PurposeIntraspinal tuberculoma is a rare disease in children, and its imaging findings have been described in only a few case reports. This study aimed to investigate the magnetic resonance imaging (MRI) features of pediatric intraspinal tuberculoma and to explore the possible pathogenesis of the disease.Materials and MethodsThe clinical and MRI data of 24 child patients with intraspinal tuberculoma (such as 6 cases of intramedullary tuberculoma, 8 cases of intradural extramedullary tuberculoma, and 10 cases of epidural tuberculoma) were retrospectively analyzed. All patients underwent plain and contrast-enhanced MR scans. The diagnosis was confirmed by surgical pathology or by antituberculous treatment and follow-up data.ResultsIntramedullary tuberculoma had a round shape, while intradural extramedullary tuberculoma and epidural tuberculoma presented long-fusiform or en plaque shapes. Regarding MRI signals, intramedullary tuberculoma and extramedullary tuberculoma were mainly isointense on T1-weighted imaging (T1WI) and hypointense or isointense on T2WI. Rim enhancement was observed in intramedullary tuberculoma, and marked homogeneous enhancement was dominant in extramedullary tuberculoma. Ten (10/24) tuberculomas occurred during antituberculous therapy, with intradural extramedullary tuberculoma accounting for 7 cases (7/8), which was significantly more frequent than intramedullary tuberculoma (1/6) or epidural tuberculoma (2/10).ConclusionMRI is important in the diagnosis of intraspinal tuberculoma, which is characterized by isointensity on T1WI, isointensity, or hypointensity on T2WI, and rim or obvious homogeneous enhancement. Some intraspinal tuberculomas, especially intradural extramedullary tuberculomas, might be associated with the “paradoxical response” mechanism during the tuberculosis treatment.

Intramedullary tuberculoma of thoracic spine: A rare location of an endemic disease

Tuberculosis (TB) is endemic in India, alone contributing for two thirds of total cases worldwide. Spinal tuberculosis accounts for 1-2% of all cases of tuberculosis. However, spinal intramedullary tuberculoma occurs in as few as 2 out of 1000 cases of tuberculosis involving central nervous system. This may present in form of meningitis, tubercular spondylitis, arachnoididtis or tuberculomas mostly. The most common site of involvement is found to be the thoracic region of spine affecting relatively younger age groups and often seen in association with extraspinal tuberculosis disease. The source of intramedullary tuberculosis is mostly hematogenous spread from a site of primary TB elsewhere in the body which is usually the lungs.Due to rarity of the disease misdiagnosis is frequent.Magnetic Resonance Imaging is the investigation of choice and histopathological examination and culture are confirmatory methods for diagnosis of tuberculosis.Microsurgical resection is better option for rapidly progressing intramedullary tuberculosis cases. Here we report a rare case of isolated spinal intramedullary tuberculoma of thoracic spinal region.

Study on the expression level of NF-κB and clinical evaluations in spinal tuberculosis patients.

Spinal tuberculosis or tuberculous spondylitis is one of the most common types of skeletal tuberculosis. Complications of the spine and spinal cord tuberculosis include destruction of the vertebrae, deformity, and paraplegia. Since in some patients, the clinical manifestations of tuberculosis are unusual and timely diagnosis and treatment of this disease can prevent its serious consequences, so in the present study, some cases of rare manifestations of tuberculosis were investigated. The expression of the NF-κB gene in these patients was also evaluated. In this regard, 36 patients with spinal tuberculosis and 30 healthy individuals (as a control group) were assessed. Clinical symptoms, imaging, laboratory tests, pathology, and response to treatment related to patients with spinal tuberculosis and spinal cord tuberculosis were evaluated. NF-κB expression was also evaluated using the PCR technique in peripheral white blood cell samples. The obtained results were analyzed using SPSS ver. 16, χ2 and T-test statistical methods. Mann-Whitney U test and Kruskal-Wallis non-parametric tests were used to analyze non-parametric data. The results showed that out of 36 cases of spinal tuberculosis, 29 cases had spinal tuberculosis, five cases had tuberculous radiculomyelitis, one case had spinal intramedullary tuberculoma, and one case had syringomyelia. 52.78% of patients were male, and 70% of cases were observed between the ages of 35 and 55 years. Fever and back pain were seen in more than 80% of cases. The study of NF-κB expression in the control and case groups showed that the NF-κB expression in the case group increased compared to the control group. This increase was statistically significant (P = 0.0071). In general, in the present study, the methods of clinical diagnosis of spinal tuberculosis were evaluated. Also, the amount of NF-κB transcription factor was evaluated as an effective genetic factor in the diagnosis of this disease.

SURGICAL MANAGEMENT OF INTRAMEDULLARY TUBERCULOMA: A CASE REPORT AND REVIEW OF LITERATURE

Tuberculosis (TB) is a common disease of developing countries especially in immunocompromised population. Most of the Central Nervous System (CNS) lesions in tuberculosis are intracranial with the ratio of cranial and spinal lesions averaging 42:1. Medical therapy with antitubercular drugs is the mainstay of the treatment modality for a conrmed lesion. We report a case of intramedullary spinal tuberculoma managed surgically, which did not respond to the medical management with radiological expansion and clinical deterioration. Surgical excision denitely has role in management of intramedullary tuberculoma. Early surgical intervention may provide better outcome if neurological symptoms appear or lesion size increases despite on antitubercular drug therapy.

The ring in the neck-managing paraparesis in cervical intramedullary tuberculoma: Inputs from a neurorehabilitation desk

Central nervous system (CNS) tuberculosis is a less common entity even in endemic countries like India. Involvement of spine is much less frequent than brain, but concurrent involvement of brain and spine by tuberculoma is rare. A 23-year-old female with paraparesis was diagnosed as having cervical ring enhancing lesion in MRI suggesting intramedullary tuberculoma along with long segment cervicodorsal edema. On brain screening she had multiple intracerebral tuberculomas without any evidence of tuberculosis elsewhere in the body. She was treated with a multidisciplinary approach including neurological management and neurorehabilitation, with remarkable clinical recovery. In presence of acute neurological deficit, early start of rehabilitation along with medical management can give outstanding results in terms of neuro-recovery and improvement of residual neurodeficits. Surgical intervention can be avoided in many cases.

A rare case of disseminated tuberculosis; multiple intracranial and intramedullary tuberculomas with concurrent tuberculous spondylitis and meningitis

Concomitant presentation of intracranial and intramedullary tuberculomas is a rare entity. We report a 38-year-old immunocompetent woman with intramedullary and intracranial tuberculomas with concurrent tuberculous spondylitis and meningitis, who presented with paraparesis and back pain. Despite initial antituberculous therapy, the patient’s neurologic status deteriorated with the development of paraplegia. Following surgical intervention, the patient gradually recovered muscle strength and bladder function.

Multiple Intracranial Tuberculomas with an Intra-medullary Spinal Cord Tuberculoma in a Pediatric Patient

Central nervous system (CNS) tuberculosis (TB), caused by Mycobacterium tuberculosis (MT), is a severe form of TB, which presents as meningitis, cerebritis, abscesses, spinal tuberculous arachnoiditis, and rarely tuberculomas. CNS TB is prevalent in the underdeveloped or developing world and is common in malnourished, alcoholics, children, young adults, immunocompromised, and cancer patients. Intracranial tuberculomas (ICT) can present with symptoms and signs of focal neurological deficits with or without systemic manifestations. ICT is the least common presentation of CNS TB. Medical management with anti-TB drugs and steroids is the mainstay of treatment, while surgical intervention is usually reserved for refractory cases. Here, we present the case of a 10-year-old Indian American girl with headaches, diplopia, fever, and neck pain diagnosed with ICT and intramedullary spinal cord tuberculoma.

Tuberculoma of the conus medullaris

A 52 year old female presented with a one month history of progressive back pain radiating to the right lower limb. She reported unintentional weight loss of seven kilograms over three months and drenching night sweats. There was no history of cough. Her physical examination was unremarkable. A HIV ELISA test was positive. Her CD4 count was 27 cells/mm3 and viral load was 1.8 million copies/ml. An MRI spine (A,B) to evaluate the back pain revealed a single spinal ring enhancing lesion at T12 with minimal perilesional edema. A chest CT scan was in keeping with miliary tuberculosis. Sputum TB GeneXpert was positive for Mycobacterium tuberculosis. Anti TB therapy was initiated with subsequent resolution of back pain. Back pain in a patient with miliary TB may indicate vertebral involvement or rarely, as in this case, intramedullary tuberculomas. Prognosis is usually good.

Intramedullary tuberculoma of the Spinal Cord, Clinical features & imaging: Possibility of early diagnosis with imaging?

Involvement of vertebral column is common in tuberculosis(TB) but intramedullary tuberculomas are rare. Spinal intramedullary tuberculoma are extremely rare, seen in only 2 of 100,000 cases of TB and 2 of 1000 cases of CNS TB. Intramedullary tuberculomas normally respond well to conventional antituberculous medications, requiring surgery only occasionally. MRI is optimal diagnostic modality in intramedullary tuberculoma as it can show specific findings. This report describes a case of Intramedullary Tuberculoma of the Spinal Cord with clinical features and specific MRI findings with review of litreture.

Intramedullary tuberculoma of spinal cord, in association with TB intestine and pleural effusion responded to antitubercular therapy: a case report

Intramedullary tuberculoma of spinal cord, in association with TB intestine and pleural effusion responded to antitubercular therapy: a case report

MRI Imaging of Spinal Intramedullary Tuberculoma

MRI Imaging of Spinal Intramedullary Tuberculoma

Unusual case of in vivo detection of intradural intramedullary tuberculoma

Unusual case of in vivo detection of intradural intramedullary tuberculoma

Concurrent Pulmonary, Intracranial, Intramedullary Tuberculoma, and Their Response to Conservative Management

AbstractTuberculomas of the central nervous system are common. However, the incidence of intraspinal intramedullary tuberculomas is very low, and a combination of intramedullary, intracranial, and pulmonary tuberculomas is extremely rare. We report a case of tuberculoma involving the brain and spine with pulmonary tuberculosis in a 46-year-old man initially presenting with back pain and weakness of both lower extremities. Conservative treatment with antituberculous medications resulted in complete resolution of his symptoms.

Intra Medullary Tuberculoma Presenting as Brown Sequard Syndrome with Concurrent Intradural Extramedullary Tuberculoma and Arachnoiditis

Intra Medullary Tuberculoma Presenting as Brown Sequard Syndrome with Concurrent Intradural Extramedullary Tuberculoma and Arachnoiditis

Intracisternal tuberculoma: a refractory type of tuberculoma indicating surgical intervention

BackgroundCentral nervous system (CNS) tuberculoma is a rare disease with severe neurological deficits. This retrospective research is to review the data of patients diagnosed as CNS tuberculoma. Surgeries were performed in all patients. The clinical features especially the neurological image and the anatomical characters of the tuberculomas were concerned.MethodsTotally 11 patients diagnosed as CNS tuberculoma were admitted in Guangzhou First People’s Hospital (7cases) and Changzheng Hospital (4 cases) during 2006–2015. The data including preoperative condition, neurological imaging, and surgical findings was collected and analyzed.ResultsThe lesions of nine patients (9/11) were totally or subtotally excised and two (2/11) were partially excised. Neurological functions of all patients were improved after surgery without secondary infection. Lesions of nine (9/11) patients preoperatively progressed as a result of paradoxical reaction. Of the 9 patients demonstrated paradoxical progression, all lesions were partially or totally located at the cisterns or the subarachnoid space. Preoperative ATTs lasted 2 to 12 months and tuberculomas were not eliminated. The arachnoid was found thickened and tightly adhered to the lesions during surgeries. Of the 2 cases that paradoxical reaction were excluded, both patients (case 6, intramedullary tuberculoma; case 11, intradural extramedullary tuberculoma) were admitted at onset of the disease. ATTs were preoperatively given for 1 week as neurological deficits aggravated. The tuberculous lesions of CNS or other system showed no obvious change and paradoxical reaction could not be established in both cases.ConclusionsExudates of tuberculosis is usually accumulated in the cisterns and frequently results in the paradoxical formation of tuberculoma. Intracisternal tuberculoma is closely related to paradoxical reaction and refractory to anti-tuberculosis therapy. Micro-surgical excision is safe and effective. Early surgical intervention may be considered in the diagnosis of intracisternal tuberculoma especially when paradoxical reaction participates in the development of tuberculoma.

Spinal Tuberculosis: Clinicoradiological Findings in 274 Patients.

Mycobacterium tuberculosis is a major cause of myelopathy and radiculopathy in settings with a high prevalence of tuberculosis/human immunodeficiency virus (HIV) coinfection. However, a paucity of publications exists on the spectrum of neurological and magnetic resonance (MR) imaging findings of spinal tuberculosis in these populations. We conducted a retrospective study of adults with spinal tuberculosis at a referral center in South Africa for patients with spinal disease without bony involvement seen at plain film radiography. We report the clinical, laboratory and spinal MR imaging findings, compare HIV-infected and HIV-uninfected patients, and correlate clinical and cerebrospinal fluid findings with those of MR imaging. Of 274 patients, 209 (76%) were HIV infected and 49 (18%) were HIV uninfected. Radiculomyelitis occurred in 77% (n = 210), and spondylitis in 39% (n = 106). Subdural abscess (n = 42) and intramedullary tuberculoma (n = 33) were common. In 24% of HIV-infected and 14% of HIV-uninfected patients, spinal disease manifested as a paradoxical tuberculosis reaction, frequently following tuberculous meningitis. The triad of neurological deficit, fever, and back pain was similar in patients with spondylitis (24%), epi/subdural abscess without bony disease (14%), meningoradiculitis (17%), and isolated myelitis (17%) . Radiculomyelitis is a common manifestation of spinal tuberculosis in settings with high tuberculosis/HIV prevalence, often presenting as a paradoxical reaction. We describe a high frequency of rarely reported spinal tuberculosis manifestations, suggesting that these are more common than implied by the literature.

Spinal Intramedullary Tuberculoma with Abscess:Rare Occurrence

Spinal Intramedullary Tuberculoma with Abscess:Rare Occurrence