An Unusual Case of Craniovertebral Junction Tuberculosis in an Infant

Kapoor, Satwanti; Tiwari, Afy; Chaudhry, Aashish

doi:10.1097/brs.0b013e318158cd4c

Cited by 9 publications

(6 citation statements)

References 9 publications

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“…The MRI findings of IMT are well documented. 11 The IMT was clearly shown with enhanced MRI in the patient in our study, which helped to reach a prompt diagnosis.…”

Section: Discussionsupporting

confidence: 66%

Intramedullary Cervical Tuberculoma: A Case Report With Note on Surgical Management

Guo

Chen

2015

International Surgery

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This study aims to report a relatively rare entity-intramedullary tuberculum of cervical spine-and describe its management and some key learning points. Intramedullary tuberculomas are rare entities. Intramedullary tuberculoma is most commonly found in the thoracic cord of a patient and is rarely seen in the cervical cord. We present an intramedullary cervical tuberculoma in a 21-year-old patient with finding of spinal cord compression. All 4 limbs were spastic, with grade 1 power on the right side and grade 3 power on the left side. Sensory deficit was found below the C6 level. Magnetic resonance imaging showed an intramedullary lesion at the C5 to C6 levels. Intramedullary tuberculoma was diagnosed based on clinical symptoms, physical examination, previous history, and magnetic resonance imaging. A C5 to C7 laminectomy was performed. Intramedullary tuberculoma was resected by microsurgery. One year after the surgery, strength returned to normal grade 5. Excellent clinical outcome was obtained with a combination of both medical and surgical treatments. Intramedullary cervical tuberculoma should be removed without delay to eliminate any mass effect on the neurons as soon as possible.

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“…The MRI findings of IMT are well documented. 11 The IMT was clearly shown with enhanced MRI in the patient in our study, which helped to reach a prompt diagnosis.…”

Section: Discussionsupporting

confidence: 66%

Intramedullary Cervical Tuberculoma: A Case Report With Note on Surgical Management

Guo

Chen

2015

International Surgery

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“…However, in our own series as well as in another series, 5 % of spinal tuberculosis was at the craniocervical junction [3]. On one side there are a lot of case descriptions and several case series with more or less cases, all of them with some recommendations regarding classification [19], the establishment of diagnosis and the value of biopsy [13,16,[18][19][20][21]; furthermore, their recommendations are also related to treatment modalities [15,16] and to indications for treatment. Since craniocervical junction tuberculosis carries the risk of secondary instability and severe neuraxis compression [5], sometimes in the sense of severe bulbo-medullary complications [2] with painful torticollis, dysphagia and tetraparesis, early diagnosis is of utmost importance.…”

Section: Discussionmentioning

confidence: 93%

Tuberculosis of the craniovertebral junction

et al. 2012

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Purpose Tuberculosis (TB) of craniovertebral junction (CVJ) occurs in 1-5 % of cases of TB spondylitis. This can be a life-threatening condition due to mass effect of infective process or resultant instability. Surgical indications for TB of CVJ are not clear from literature. Methods We have reviewed all the patients with TB of CVJ admitted at our center between 2005 and 2010. Results There were 15 patients including 10 males and 5 females. Average age was 38 years and average duration of symptoms was 8 months. All patients were started on multidrug antituberculous chemotherapy and skull traction. Those patients who failed to respond in 4-6 weeks and had persistent instability or neurological deficit were offered surgery. Rest was treated conservatively by immobilisation or traction. All five patients who were surgically treated had occipitocervical fusion (OCF) with titanium screws and plate/rod construct combined with posterior decompression if needed. Only one patient needed anterior surgery in addition to OCF at a later stage. All patients improved neurologically whether they were treated surgically or conservatively. Only difference was that surgically treated patients had earlier pain relief, mobilisation, neurological improvement and lesser complications. Conclusion We recommend that all patients with TB of CVJ with instability and neurological compromise, who fail to respond to 4-6 weeks of antituberculous chemotherapy and skull traction should be offered occipitocervical fusion with or without posterior decompression. Anterior surgery will be needed only in those few cases who do not improve neurologically after OCF.

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“…Unilateral suboccipital pain with ipsilateral 12 th nerve palsy is termed as OCS. [ 1 2 3 4 5 6 ] It was first described by Greenberg in 1981. [ 6 ] It is characterized by occipital pain radiating toward the mastoid, ear, and vertex.…”

Section: Discussionmentioning

confidence: 99%

Occipital condyle syndrome in a case of rotatory atlantoaxial subluxation (type II) with craniovertebral junction tuberculosis: Should we operate on “active tuberculosis?”

Kumar

Singh

Dikshit

et al. 2020

J Craniovert Jun Spine

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Tuberculosis of the craniovertebral junction is rare as well as intriguing. We present a unique amalgamation of three rare entities: craniovertebral tuberculosis, occipital condyle syndrome, and nontraumatic type II rotatory atlantoaxial dislocation in one patient. We reviewed the limited literature available and the underlying pathophysiology to highlight the pattern of the disease presentation, progression, and response to management options. A 13-year-old girl presented with neck pain, torticollis, and right hypoglossal weakness following a fall from stairs 10 months back. Radiological investigation suggested right occipital condylar destruction with right-sided neck tilt and rotatory atlantoaxial dislocation. The contrast magnetic resonance imaging was suggestive of craniovertebral tuberculosis with primary foci in the right lung (apical cavitary lesion). In view of an intact neurological condition, she was started on antitubercular treatment and she continues to do well during the follow-up. It remains debatable if an anticipation of this problem calls for a surgical addressal at the acute stage of the disease as a delayed correction is likely to be more complex. While a halo device is preferable in these cases, it remains cumbersome and less preferred in comparison to the Philadelphia collar.

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An Unusual Case of Craniovertebral Junction Tuberculosis in an Infant

Abstract: Craniovertebral tuberculosis is difficult to diagnose and treat in infants. A high index of suspicion is essential for a prompt diagnosis and treatment, which is all the more crucial in this age group.

Cited by 9 publications

References 9 publications

Intramedullary Cervical Tuberculoma: A Case Report With Note on Surgical Management

Intramedullary Cervical Tuberculoma: A Case Report With Note on Surgical Management

Tuberculosis of the craniovertebral junction

Occipital condyle syndrome in a case of rotatory atlantoaxial subluxation (type II) with craniovertebral junction tuberculosis: Should we operate on “active tuberculosis?”

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