Disseminated tuberculomas in spinal cord and brain demonstrated by MRI with gadolinium-DTPA

Abstract

Intramedullary tuberculoma is rare, and there has been no report of concurrent intramedullary and intracerebral tuberculomas. We report a 30-year-old man with miliary tuberculosis of the lung. He suffered sudden paraplegia due to tuberculomas in the thoracic spinal cord and MRI showed more tuberculomas in the cervical spinal cord, brain stem, and cerebral and cerebellar hemispheres. The tuberculomas were isointense on the T1-weighted images, and hyperintense on the T2-weighted images; there was marked enhancement with intravenous gadolinium-DTPA. All the tuberculomas were very small 1 year after antituberculous chemotherapy.

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

“…In both cases, the intracranial lesions were incidentally discovered, as in our patient. However, in the cases reported by Huang et al 6) Shen et al 19) and Muthukumar et al 13) , the patients were symptomatic for both intracranial and intramedullary lesions. Most of the reported intramedullary spinal tuberculomas are solitary.…”

“…Arseni and Samtica found only five intramedullary tuberculomas in their series of 210 cases of CNS tuberculosis 2) . Concurrent intramedullary and intracranial tuberculomas are very rare and only 5 cases has been Disseminated Tuberculoma in Spinal Cord and Brain｜HS Park, et al reported so far 6,13,19,21,23) . Thacker and Puri 21) reported a 6-year-old girl who presented with progressive paraparesis in whom imaging revealed intramedullary tuberculoma with incidentally discovered multiple intracranial tuberculoma.…”

“…Most of the reported intramedullary spinal tuberculomas are solitary. However, multiple intramedullary spinal tuberculomas have been increasingly reported after the use of MRI was introduced 7,8,10,11,15,16,19) . We suggest that MRI of the brain should be performed in the case of multiple intramedullary spinal tuberculomas because of the possible presence of early asymptomatic intracranial tuberculomas.…”

“…Among patients with spinal tuberculosis, 55% present with vertebral body involvement, 39% with intraspinal granulomatous lesions without bone involvement, and only 7% with intramedullary lesions 13) . The combination of intramedullary and intracranial tuberculomas is extremely rare and only five cases have been reported in the literature 6,13,19,21,23) . Most cases of intramedullary tuberculomas are subacute with progressive spinal cord compression symptoms.…”

Intramedullary tuberculoma of the conus medullaris: case report and review of the literature

“…The advent of MRI may facilitate the diagnosis of an intramedullary mass consistent with tuberculoma. 7,13 The prognosis for neurologic improvement is good with appropriate therapy. 3,12,14 Medical therapy remains the mainstay of treatment, but when confronted with a progressing neurologic de®cit, surgery may be indicated.…”