Intramedullary Spinal Tuberculoma-Case Report-

Abstract

A healthy 33-year-old man presented with an intramedullary tuberculoma of the thoracic spinal cord manifesting as a 2-month history of progressive paraparesis and sphincter dysfunction. Magnetic resonance imaging showed ring enhancement of the intramedullary thoracic lesion with perifocal edema. General physical examination was unremarkable with no signs of inflammation except for a positive finding by the tuberculin skin test. Total resection of the intramedullary mass was performed through a posterior myelotomy following T11-12 laminectomy. Histological examination revealed a granulomatous lesion that contained Langhans giant cells, inflammatory cells, and caseating necrosis. Acid-fast bacilli staining of the specimens was positive, and cultures grew Mycobacterium tuberculosis. Postoperatively, the paraparesis and sphincter dysfunction improved sufficiently for the patient to return to his ordinary activities. Intramedullary spinal tuberculoma is rare, but must be considered in the differential diagnosis of spinal cord compression.

Intramedullary cervical tuberculoma

“…Later, the capsule becomes richer in collagen, resulting in ring enhancement. 1,7 Pathological changes include non-caseating granuloma, cascating granuloma with a solid centre and caseating granuloma with liquid centre. 7 MRI describes three types of tuberculoma pictures: tuberculous lesion appears isointense on T1WI with cord expansion, and isointense to hypointense on T2WI, and ring enhancement with hypointense centre on Gd-DTPA MR scan.…”

“…Tuberculosis of the central nervous system (CNS) is rare, with an incidence of only 0.5-2% of patients with systemic tuberculosis. 1 Tuberculoma of the CNS is unusual, whereas intramedullary tuberculomas are rare. [1][2][3][4][5] We report a case of intramedullary cervical tuberculoma that was cured by a combination of operation and antituberculous chemotherapy.…”

Intramedullary thoracic tuberculoma

“…4 One-third of patients with IMT may show only signs of spinal-cord compression, but no symptoms of systemic tuberculosis. 5 As the diagnosis of IMT is usually difficult and inconclusive, the needed surgical and pharmacological treatment can be significantly delayed or neglected. Accordingly, we suggest that the diagnostic and therapeutic surgical resection of the intramedullary lesion should be carried out without delay in patients with deteriorated neurological Figure 1 Magnetic resonance imaging (MRI) of the thoracic spine showed an enlargement of the spinal cord between T-6 and T-7 level, isointensive on T1-weighted imaging (left, arrow), ring isointense lesion surrounding the edema on T2-weighted imaging (middle, arrow) and ring enhancement (right, arrow) at the T6-7 intervertebral level.…”

Tuberculose intramédullaire. À propos d’un cas

“…Lors de la dernière décennie, peu de cas ont été décrits (Muthukumar et al, 2006 ;Li et al, 2006 ;Torii et al, 2004 ;Ibahioin et al, 2004 ;Chagla et al, 2007 ;Skoglund et Nilsson, 2006 ;Lin et al, 2006). Les cas décrits étaient pour la plupart dans des pays émergents où la prévalence de la maladie tuberculeuse est beaucoup plus forte que dans les pays dits industrialisés.…”