Intramedullary Tuberculoma Research Articles

Intramedullary conus medullaris tuberculoma in an HIV-infected child: an unusual immune reconstitution inflammatory syndrome response

A human immunodeficiency virus-infected girl with previous cerebral tuberculosis presented with paraparesis and sphincter dysfunction after improvement in her CD4 count, following antiretroviral therapy. Magnetic resonance imaging of her spinal cord revealed a conus medullaris lesion, in keeping with a tuberculoma. Her neurological signs improved after initiating tuberculosis treatment and steroids. It is most likely that this case demonstrates an unusual central nervous system immune reconstitution inflammatory syndrome (IRIS) response and is probably the first reported case of conus medullaris tuberculoma IRIS in the literature.

A rare case of intramedullary tuberculoma: Complete resolution after medical treatment and role of magnetic resonance imaging in diagnosis and follow-up

Intramedullary tuberculoma (IMT) is a rare form of spinal tuberculosis. IMT has an incidence of 2 cases per 2000 cases of central nervous system tuberculosis. Magnetic resonance imaging (MRI) can be helpful for diagnosing IMT at an early stage and it is also very useful in follow-up. Three stages of IMT have been described in MRI based on the evolution of the lesion. Medical therapy is the mainstay of treatment for IMT though there are surgical options for select patients. Here, we describe a patient with dorsal IMT who improved clinically as well as radiologically with antituberculous treatment and steroids.

Intra-medullary tuberculoma of the spinal cord presenting with typhoid and paraplegia: a case report

IntroductionIntra-medullary spinal tuberculoma is a rare form of tuberculosis, with an incidence of only two in 100,000 patients with tuberculosis. We present a case of intra-medullary tuberculoma from Pakistan, which was diagnosed by radiological findings and analysis of cerebrospinal fluid using polymerase chain reaction testing.Case presentationWe present the case of a 28-year-old Sindhi male with intra-medullary tuberculoma of the spinal cord at the C3 level. Our patient was treated solely with anti-tubercular drug therapy with no surgical intervention.ConclusionsWe discuss the possible clinical management of such rare cases, considering both chemotherapeutic and surgical options. Additionally, diagnostic procedures and findings are discussed; we suggest cerebrospinal fluid analysis via polymerase chain reaction and gadolinium-diethylenetriamine pentaacetic acid magnetic resonance imaging as important chemical and radiological tests to be performed in such cases.

Cervical intramedullary conglomerate tuberculomas with tuberculous meningitis — rapid response to medical therapy

Common manifestations of tuberculosis of the central nervous system are tuberculous meningitis and intracranial tuberculomas. Cervical intramedullary tuberculomas are very rare in immunocompetent children. An unusual presentation of tuberculous meningitis with hydrocephalus and conglomerate cervical intramedullary tuberculomas in a 4-year-old boy is reported.

Concurrent intra-cranial and intra-medullary tuberculomas associated with tubercular lymphadenitis

Concurrent intra-cranial and intra-medullary tuberculomas associated with tubercular lymphadenitis

Central nervous system tuberculoma

The aim of this study was to outline the clinicoradiological features of central nervous system (CNS) tuberculoma, and highlight the importance of early treatment. We conducted a retrospective analysis between 1999 and 2008. Clinicoradiological, pathological and follow-up data of 23 patients were reviewed and analysed. The mean age at presentation was 30.3years (range=17–43years), and the average disease duration at presentation was six months (range=1–19months). The tuberculoma location in the cohort was: thoracic region (10 patients); cervical region (six), cervicothoracic region (three); thoracolumbar region (one); and intracranial (six); three patients (13%) had multiple lesions. Nineteen (82.6%) and 15 (65.2%) patients had sensory-motor and bowel/bladder involvement, respectively. Two patients presented with headache and consciousness disturbance, and two patients had a history of pulmonary Koch’s disease. Five patients had a history of tuberculous meningoencephalitis, and one patient had a history of enlarged cervical lymph nodes. Twenty-one patients underwent surgery, and two received conservative treatment; all patients received anti-tuberculosis therapy for 18months. Seventeen of the 21 surgical patients and both conservatively managed patients achieved improved neurological function (with Karnofsky Performance Scale scores of 90–100). Patients presenting at an advanced disease stage had a poorer outcome. CNS tuberculoma is a benign condition with a good prognosis and effective therapy options. Enhanced brain and spine MRI should be performed to ensure the diagnosis is not missed. Early surgical decompression is recommended for intramedullary tuberculoma. Craniotomy is indicated for patients with intracranial hypertension, while more conservative therapy is appropriate for patients who have intracranial tuberculomas without intracranial hypertension.

Intramedullary granuloma suggestive of tuberculoma

.CASEA 26-year-old woman presented with two-month back pain followed by paraparesis. At admission unit, the patient presented with urinary retention and parapa -resis grade II. Magnetic resonance images demonstrated intramedullary lesion, at C7-T1 level, with ring contrast enhancement (Fig 1A, 1B, 1C), and lytic lesion on T8 vertebral body (Fig 1D). The patient tested negative for HIV. In view of the evidence of tuberculosis by the radio -logical appearance in T8 level, a presumptive diagnosis of intramedullary tuberculoma was made, and the pa-tient received chemotherapy. However the neurological deficits worsened and the surgery was planned. A lami-notomy at C7-T1 level was done followed by debulking of the lesion microsurgically.Histopathologic examination revealed lymphocytes, epithelioid cells, and Langerhans giant cells indicative of tuberculoma (Fig 1E, 1F). Cultures were negative and PCR has not been done. Postoperatively, patient showed gradual improvement in power over a period of six months.DISCUSSIONThe common location of intramedullary tuberculoma is the thoracic cord and less commonly in the cervical and lumbar regions. The best imaging modality for diag-nosis is magnetic resonance image

Revisiting the CNS Tuberculosis with Emphasis on Giant Tuberculomas and Introducing the “Outer Rim Excrescence Sign”

Central nervous system tuberculosis is a leading cause of morbidity and mortality in developing countries with Mycobacterium tuberculosis as the main etiological agent. Classical imaging findings pose no problem for diagnosis of CNS tuberculosis. Cases of giant or solitary ring enhancing lesions are increasing which mimic other infectious and noninfectious pathologies. This is a retrospective study of 40 patients (28 male and 12 female) of either surgically or clinically proven CNS tuberculosis. Solitary tuberculomas (ring or solid enhancing) were seen in 19 patients. Four patients showed presence of two to three lesions and the lesion more than one centimeter size was categorized as 'giant tuberculoma'. Multiple lesions with other associated findings were noted in 21 patients. Total 33 patients showed solitary or multiple ring enhancing lesions. Seven patients showed solid enhancing lesions (giant tuberculoma). The "Outer rim excrescence sign" was noted in a total of 16 patients. Both brain and spinal tuberculosis was noted in six patients. Seven patients presented with meningitis and hydrocephalous which is considered as the most common manifestation in the literature. Spinal leptomeningeal involvement was seen in five patients, whereas intramedullary cord tuberculomas were noted in four patients. Profound T2W hypointensity is a reliable predictor for giant tuberculomas with intense contrast enhancement, especially in deep locations. 'Outer rim excrescence' sign may contribute in cases of ring and solid enhancing lesions, however it requires further comprehensive study with MT Imaging and MR Spectroscopy to be recorded as a differentiating feature.

Tuberculoma intramedular en paciente inmunocompetente

We present the case of a 26 year old male patient, with a subacute compromise of muscle strength in his lower limbs and urinary retention. The presence of an intramedullary tuberculoma was documented. The patient received corticosteroids and anti-tuberculous therapy, with a total resolution of the symptoms. A short a literature review is also included.

Isolated intramedullary tuberculoma of the dorsal cord: a rare clinico-radiological entity

Tuberculous infection manifesting as an isolated intramedullary tuberculoma of the spinal cord is distinctly unusual. We report a case of a 35 year old woman presenting with an insidious onset of myelopathy, where MRI showed characteristic imaging findings suggestive of intramedullary tuberculosis.

Why Do We Not Have Resolution on an Ancient Disease of the Spine?

Tuberculous involvement of the spinal cord parenchyma is an exceedingly rare clinical entity; even more so is concurrent intracranial tuberculosis (TB). Spinal intramedullary TB presents with a characteristic subacute myelopathy, with slowly progressive paraplegia, sensory deficits, and/or bowel and bladder dysfunction. Diagnosis is strongly suspected with a clinical history of known TB in conjunction with characteristic findings on magnetic resonance imaging. Management involves multiagent antitubercular chemotherapy without or with operative intervention.We present a case of a 9-month-old boy with a retrospectively recognized history of pulmonary TB presenting with fever and back tenderness found to have lower-extremity hypertonia and clonus. Imaging revealed concurrent intracranial and spinal intramedullary tuberculomas. The patient was treated for hydrocephalus with external ventricular drainage followed by T8–T10 laminectomy, drainage of abscess, and duraplasty. Parietal lobe biopsies proved the tuberculous etiology of intracranial lesions.Etiopathogenesis, diagnosis, and management considerations of spinal intramedullary tuberculosis are reviewed and discussed.

Imaging Diagnosis of Spinal Intramedullary Tuberculoma: Case Reports and Literature Review

Background/Objective: Spinal intramedullary tuberculoma is rare, accounting for 2/100,000 of cases of tuberculosis and only 2% of all cases of tuberculosis of the central nervous system. Diagnostic imaging is essential to improving diagnosis and management of this disease.Methods: The clinical profile, radiological data, and histological slides of 2 cases of intramedullary tuberculomas confirmed by pathologic examinations were reviewed.Results: In 2 cases, magnetic resonance imaging (MRI) showed thickening of the spinal cord and oval lesions with a low T1-weighted image signal and a typical “target sign” T2-weighted image signal. After gadopentetate dimeglumine administration, the lesion's rim shape was enhanced, showing uneven wall thickness and sharp margins.Conclusions: MRI findings of spinal intramedullary tuberculoma were specific, and accurate diagnosis could be obtained. MRI is the optimal measure because it shows location, size, and number of lesions and the presence of degeneration and necrosis.

Intramedullary tuberculoma in a six year old

Intramedullary tuberculoma in a six year old

Neurological complications of miliary tuberculosis

Introduction The symptomatic central nervous system involvement is often seen in patients with miliary tuberculosis. Materials and methods In this study, we evaluated 60 consecutive miliary tuberculosis patients, who presented with some neurological manifestations. Evaluation included neurological examination, a battery of blood tests, HIV serology, sputum examination, cerebrospinal fluid (CSF) examination along with imaging of the brain and spinal cord. The patients were followed up after completion of 6 months of antituberculous treatment. Results Patients ranged between 14 and 53 years in age. Three patients tested HIV positive. Forty-eight (80%) patients had tuberculous meningitis. In 12 (20%) patients, the CSF examination was normal. In 27 patients with tuberculous meningitis, neuroimaging revealed intracerebral tuberculoma. Fourteen patients showed multiple tuberculomas, while 7 had a solitary tuberculoma. In six patients, the tuberculomas were small and numerous. In two patients, neuroimaging revealed a spinal tuberculoma. For three patients with tuberculous brain masses, the CSF was normal. Nine (15%) patients presented with myelopathy. Three patients exhibited Pott's paraplegia. Three patients had transverse myelitis (with normal neuroimaging). In three patients, the spinal MRI revealed an intramedullary tuberculoma. On follow-up, 15 (25%) patients expired. Thirty-one (52%) patients showed significant improvement. Eight patients (13%) showed nil or partial recovery. Six of the patients with no improvement developed vision loss. Six (10%) patients were lost to follow up. Conclusion A variety of neurological complications were noted in military tuberculosis patients, tuberculous meningitis and cerebral tuberculomas being the most frequent complications. However, a majority of patients improved following antituberculous treatment.

Clinicoradiological presentation, management options and a review of sellar and suprasellar tuberculomas

Clinicoradiological presentation and management of patients with sellar and suprasellar tuberculomas (SST) were reviewed. The SSTs of eight patients were divided into five radiological subgroups: a sellar–suprasellar mass ( n = 3); multiple coalescing ring enhancing granulomas ( n = 2); an intrasellar abscess ( n = 1); pachymeningitis with suprasellar extension ( n = 1); and skull-base lesion involving the sella ( n = 1). The predominant endocrinopathies were hypogonadism, hypothyroidism and diabetes insipidus. The management options included surgery utilizing the frontotemporal, transylvian approach ( n = 4) or the transsphenoidal approach ( n = 1), stereotactic biopsy and ventriculoperitoneal shunt ( n = 1); endoscopic transsphenoidal biopsy ( n = 1); and antituberculous therapy (ATT) without surgery ( n = 1). All patients received ATT for 15–18 months. Patients with rapid visual deterioration ( n = 2) or with associated intramedullary tuberculoma ( n = 2) also received steroids for 2 weeks. At follow-up (range 10 months to 5.5 years; mean 3.2 years), the radiological response to ATT was evaluated. MRI after ATT showed resolution of SST in all except two patients with solid lesions. However, these lesions were smaller and had reduced contrast enhancement on imaging. Thus, SST may present with five radiological subtypes. Surgery is useful in obtaining histology. Short-term steroid therapy with ATT may reduce edema and adhesions around the optic nerve when rapid visual deterioration occurs and relieve symptoms of raised intracranial pressure. The often-associated hypopituitarism indicates the requirement for preoperative hormonal evaluation.

Intramedullary tuberculoma during infliximab therapy

Intramedullary tuberculoma during infliximab therapy

Co-Occurrence of Intracerebral Tuberculoma With Lumbar Intramedullary Tuberculoma

Tuberculosis is common in India, but the co-occurrence of intracranial and intramedullary tuberculomas as a manifestation of central nervous system tuberculosis is extremely rare in children. We report a case of concurrent intracranial and lumbar intramedullary tuberculomas in a 6-year-old girl. The child developed the intracranial and intramedullary tuberculomas while on antituberculous therapy for previously diagnosed tuberculous meningitis. The child improved well on antituberculous drugs and neurosurgical excision of the lumbar lesion. Histopathology confirmed tuberculous etiology of the intramedullary lesion.

Tuberculome du cône médullaire : à propos d’un cas et revue de la littérature

Tuberculomas of the spinal cord are rare. The objective of this study was to illustrate the diagnosis and treatment of tuberculomas of the conus medullaris. They must be suspected in patients with a clinical context and a typical spinal cord mass lesion. Treatment is primarily medical. Surgery is reserved for cases of rapid neurological deterioration or doubts concerning the diagnosis. We report a case of intramedullary tuberculoma of the conus in a 27-year-old woman with paresthesias and weakness of the lower limbs who had been treated for pulmonary tuberculosis. The spinal MR showed a characteristic intramedullary ring-enhancing lesion. She improved neurologically one month after the beginning of the antituberculous drugs and a laminectomy. Seven months later, the patient is asymptomatic and the lesion has nearly completely disappeared completely.

Tuberculose intramédullaire. À propos d’un cas

Neurological symptoms of tuberculosis are rare, even if there this pathology has been on the rise for a number of years because of HIV. Intramedullary tuberculoma is an exceptional location. We report the case of a patient with no HIV or immunodepression symptoms with intramedullary tuberculoma, revealed by a clinical presentation of insidious onset of myelopathy. We will discuss the diagnosis, treatment and clinical functional follow-up. The optimal treatment seems to be a combination of microsurgical resection and antibiotic therapy.

Multiple Tuberculoma Involving the Brain and Spinal Cord in a Patient with Miliary Pulmonary Tuberculosis

Although tuberculosis of the central nervous system is well known, the incidence of intramedullary tuberculomas is low and a combination of intramedullary with intracranial tuberculomas is extremely rare. We report a case of disseminated tuberculoma involving brain and spine with miliary pulmonary tuberculosis in a 66-year-old woman initially presenting with fever, general weakness, back pain and motor weakness of both lower extremities. Despite medical therapy, she developed progressive motor weakness of both lower extremities with muscle strength 1/5 in both lower extremities. Urgent surgical intervention was followed and her muscle power and motor functions were improved gradually. The anti-tuberculous drugs were continued and the follow-up magnetic resonance imaging (MRI) of brain and spine showed that the lesions had become smaller or disappeared.