- Department of Neurosurgery, SCB Medical College and Hospital, Cuttack, Odisha, India
Department of Neurosurgery, SCB Medical College and Hospital, Cuttack, Odisha, India
DOI:10.4103/2152-7806.153844Copyright: © 2015 Mishra SS. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Mishra SS, Das D, Das S, Mohanta I, Tripathy SR. Spinal cord compression due to primary intramedullary tuberculoma of the spinal cord presenting as paraplegia: A case report and literature review. Surg Neurol Int 23-Mar-2015;6:42
How to cite this URL: Mishra SS, Das D, Das S, Mohanta I, Tripathy SR. Spinal cord compression due to primary intramedullary tuberculoma of the spinal cord presenting as paraplegia: A case report and literature review. Surg Neurol Int 23-Mar-2015;6:42. Available from: http://sni.wpengine.com/surgicalint_articles/spinal-cord-compression-due-primary-intramedullary-tuberculoma-spinal-cord-presenting-paraplegia-case-report-literature-review/
Background:Spinal cord compression can be due to various causes but spinal intramedullary tuberculoma is a rare cause. We report a case that had an intramedullary spinal cord tuberculomas in which the diagnosis was made histologically, without evidence of symptoms of systemic tuberculosis. This lesion, located in the thoracic region, mimicked as an intramedullary tumor radiologically.
Case Description:The patient was a 25-year-old male who presented with a history of progressive paraparesis. Initial diagnosis was made as an intramedullary tumor by magnetic resonance imaging (MRI). The treatment of the patient involved is complete surgical excision of intramedullary lesion followed by appropriate antituberculous therapy. Postoperatively, his neurological symptoms were dramatically improved. With combination of both surgical and medical treatments, excellent clinical outcome was obtained.
Conclusion:This case illustrates the risk of misdiagnosis and the importance of histological confirmation of a pathological lesion as spinal cord tuberculoma prior to surgical therapy, which should be kept in mind as a differential diagnosis of the intramedullary spinal cord tumors.
Tuberculosis (TB) of the central nervous system (CNS) is rare, with an incidence of 0.5–2% in patients with systemic TB[
A 25-year-old male, a worker in a garment factory, presented with complaints of band like feeling in the upper abdomen, not associated with any abdominal or back pain for 3 months duration. Simultaneously he had urinary hesitancy, a feeling of incomplete voiding of urine along with sense of inadequate evacuation of stool. Fifteen days later he developed descending paresthesia from the upper abdomen up to the both feet followed by weakness of trunk muscles, weakness and tightness of both lower limbs over a period of 2 months, which initially started in left lower limb and subsequently involved the right lower limb. There was no loss of perianal sensation. On examination, his higher mental functions and cranial nerves were normal. His upper limb power was 5 on both sides with normal tone and deep tendon reflexes. His lower limb power was 3 with hypertonia, exaggerated reflexes and ill-sustained clonus on the both side. He had sensory impairment below T5 corresponding to vertebral level D3. General physical examination and other system examinations were normal. A provisional diagnosis of thoracic myelopathy was made and patient was investigated. His complete blood count, renal profile, liver function tests, human immunodeficiency virus (HIV) and hepatitis B surface antigen were negative. His chest X-ray was normal. Erythrocyte sedimentation rate was moderately high and Mantoux was nonreactive. Magnetic resonance imaging (MRI) of whole cord revealed an iso- to hypointense lesion at D3 level on T1-weighted imaging (T1WI). The lesion was iso- to subtle hyperintense with central flow void onT2-weighted imaging (T2WI) [
Tuberculomas involving the CNS are not uncommon in developing countries. Most of these lesions are intracranial, with the ratio of cranial and spinal lesions averaging 30:1.[
Spinal TB can present in various forms, which include Pott's spine (64%), arachnoiditis (20%), intramedullary involvement (8%), and other rarer forms such as subdural and extramedullary involvement (8%).[
Clinically, patients with intramedullary tuberculomas present with signs and symptoms depending on the location of tuberculoma in the spinal cord.[
The traditional investigative modality of myelography has been replaced by the more accurate modality of MRI. The first MRI documented description of tuberculoma was given by Rhoton et al. in 1988.[
The importance of surgical treatment for intramedullary tuberculoma extends to the diagnostic procedure, curative procedure, and palliation. The palliative surgical procedure was effective against the lesion responsible for the neurological deficits among intramedullary tuberculoma.[
IMST, although a rare entity, must be considered in the differential diagnosis of spinal cord tumors to avoid unnecessary surgery. If the lesion is known, medical therapy with ATT is the mainstay of the treatment. But timely surgical decompression in selected cases, followed by ATT provide excellent long-term outcome when diagnosis is uncertain or there is clinical deterioration.
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