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Alfin JD, Akpa PO, Shilong DJ, Bot GM, Nwibo OE, Kyesmen NI, Olalere SA, Bakwa ND, Emmanuel I. Intramedullary Tuberculoma of the Conus Medularis in an Immunocompetent Young Adult with no Pulmonary Tuberculosis, the Challenges of Diagnosis and Management: A Case Report and Review of Literature. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2023; 13:113-117. [PMID: 37228891 PMCID: PMC10204907 DOI: 10.4103/jwas.jwas_201_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 12/19/2022] [Indexed: 05/27/2023]
Abstract
Background and Objective Intramedullary tuberculoma (IMT) of the conus medullaris is an extremely rare tumour that constitutes a diagnostic and management challenge in a resource-limited setting. We report a case of conus medullaris, IMT in a young immunocompetent, patient with no prior clinical features of pulmonary or extra-pulmonary tuberculosis. Case Summary The patient presented with six months history of progressive and persistent mid back pain and slight weakness of both lower limbs of 3 months duration. Physical examination revealed a well-nourished man with power of 3/5 and hyperreflexia on both lower limbs. Chest radiograph and other investigations for tuberculosis were negative. Magnetic resonance imaging (MRI) of the lumbosacral spine showed fusiform expansion of the conus medullaris, with a well circumscribed, ring enhancing, intramedullary mass straddle between T12 and L1. Patient had gross total resection with no intraoperative monitoring assistance and no post-operative worsening of neurological function. Histology showed granulomatous lesion with central caseation in keeping with a tuberculoma. Patient was commenced on post-operative anti-tuberculous therapy with physiotherapy, with full motor recovery at six months post-surgical intervention and anti-tuberculous therapy. Conclusion Intramedullary tuberculoma can be considered as one of the differential diagnoses of intradural, intramedullary tumour of the conus, even in immunocompetent individual with no clinical features of tuberculosis.
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Affiliation(s)
- Jeneral Dumura Alfin
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Philip Ojile Akpa
- Department of Anatomic Pathology and Forensic Medicine, Jos University Teaching Hospital, Jos, Nigeria
| | - Danaan Joseph Shilong
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Gyang Markus Bot
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Onyemaechi Ereke Nwibo
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Nanapan Isa Kyesmen
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Shina Abidemi Olalere
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Nenkimum Dirting Bakwa
- Division of Neurosurgery, Department of Surgery, Jos University Teaching Hospital, Jos, Nigeria
| | - Innocent Emmanuel
- Department of Anatomic Pathology and Forensic Medicine, Jos University Teaching Hospital, Jos, Nigeria
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Intramedullary Conus Medullaris Tuberculoma: A Case Report and Review of the Literature. Infect Dis Rep 2021; 13:82-88. [PMID: 33467582 PMCID: PMC7839007 DOI: 10.3390/idr13010010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 11/18/2022] Open
Abstract
Intramedullary tuberculoma (IMT) of the conus medullaris is extremely rare. We present a case of intramedullary conus medullaris tuberculoma in which the diagnosis was based on there being very high levels of adenosine deaminase (ADA) in the patient’s cerebrospinal fluid (CSF) and improvement with antituberculous therapy. A 78-year-old man presented after having had a dull ache in both thighs and progressive paraparesis. The patient’s medical history included diffuse large B-cell lymphoma, which had undergone remission due to chemotherapy two years earlier, and long-term, well-controlled diabetes. A chest X-ray showed no evidence of tuberculosis. The results of CSF analysis were compatible with Froin’s syndrome. An initial diagnosis was made of an intramedullary tumor of the conus medullaris, based on magnetic resonance imaging (MRI). A myelotomy and multiple punch out biopsy were performed, and histopathology of the tissues revealed mild reactive gliosis. Due to the patient having high levels of CSF-ADA, IMT of the conus medullaris was suspected. The patient was treated with an 18-month course of antituberculous therapy. The dull ache gradually disappeared, and motor power improved slightly. A follow-up MRI of the lumbosacral (LS) spine revealed that the lesion had completely disappeared. Intramedullary tuberculoma of the conus medullaris should be considered in patients with underlying malignancy and no symptoms of systemic tuberculosis. CSF adenosine deaminase levels can be helpful in determining the presence of central nervous system tuberculosis when other systemic signs of disease are lacking.
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Ghane VR, Shanbag P, Meshram A. Coexisting Spinal Intramedullary and Intracranial Tuberculomas in an Immunocompetent Child. J Pediatr Neurosci 2019; 14:143-147. [PMID: 31649775 PMCID: PMC6798273 DOI: 10.4103/jpn.jpn_12_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/23/2019] [Accepted: 07/22/2019] [Indexed: 11/06/2022] Open
Abstract
Pediatric neurotuberculosis manifests commonly as tuberculous meningitis and intracranial tuberculomas. The ratio of occurrence of intracranial to intraspinal tuberculoma reported is 42:1. Intramedullary tuberculomas (IMTs) are rare, and the coexistence of intramedullary and intracranial tuberculoma is extremely rare. We report a case of coexisting intramedullary and intracranial tuberculoma in a 5-year-old boy who presented with fever for 12 days, progressive motor weakness in the lower limbs for 9 days, and retention of urine and constipation for 6 days. Neurological examination revealed signs of compressive myelopathy. Magnetic resonance imaging (MRI) of the spine detected IMT at D4-D5 level of the thoracic cord with perilesional edema. MRI of brain revealed a right frontal tuberculoma. Medical management with antituberculosis therapy and steroids resulted in complete neurological recovery.
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Affiliation(s)
- Vaishali R Ghane
- Department of Paediatrics, ESI Post Graduate Institute of Medical Science and Research and ESIC Model Hospital, Andheri, Mumbai, Maharashtra, India
| | - Preeti Shanbag
- Department of Paediatrics, ESI Post Graduate Institute of Medical Science and Research and ESIC Model Hospital, Andheri, Mumbai, Maharashtra, India
| | - Ashish Meshram
- Department of Paediatrics, ESI Post Graduate Institute of Medical Science and Research and ESIC Model Hospital, Andheri, Mumbai, Maharashtra, India
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Ghali MGZ, Srinivasan VM, Kim MJ, Malik A. Spinal Intramedullary Tuberculosis with Concurrent Supra- and Infratentorial Intracranial Disease in a 9-Month-Old Boy: Case Report and Comprehensive Review of the Literature. World Neurosurg 2017; 106:37-45. [PMID: 28532916 DOI: 10.1016/j.wneu.2017.05.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/09/2017] [Accepted: 05/11/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND 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. CASE DESCRIPTION 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. CONCLUSION Etiopathogenesis, diagnosis, and management considerations of spinal intramedullary tuberculosis are reviewed and discussed.
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Affiliation(s)
- Michael George Zaki Ghali
- Department of Neurobiology & Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA; Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA.
| | | | - Marc J Kim
- Department of Internal Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Archana Malik
- Department of Pediatric Radiology, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA
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Jaiswal M, Gandhi A, Purohit D, Mittal RS. Concurrent multiple intracranial and intramedullary conus tuberculoma: A rare case report. Asian J Neurosurg 2017; 12:331-333. [PMID: 28484568 PMCID: PMC5409404 DOI: 10.4103/1793-5482.143461] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Central nervous system (CNS) tuberculosis commonly manifests as tubercular meningitis. CNS tuberculomas are more common intracranially and less frequently involve the spinal cord. Combination of intramedullary with intracranial tuberculomas is extremely rare. We report a case of concurrent occurrence of intramedullary tuberculoma with multiple intracranial tuberculomas in a young 16-year-old boy, who presented with two weeks history of paresthesias and weakness of the lower limbs and diminution of vision in left eye, who had been treated for pulmonary tuberculosis. Magnetic resonance imaging (MRI) spine showed a well-circumscribed lesion opposite L1, which was diagnosed as intramedullary tuberculoma. As for vision complaint, on cranial imaging, he was found to have multiple round contrast enhancing lesions, which were diagnosed as intracranial tuberculomas based on their typical MRI findings. He had complete recovery with conventional treatment of anti-tubercular therapy and steroids, without any surgical intervention. We suggest that MRI of the brain should be performed in all case of intramedullary spinal tuberculoma because of the possible presence of early asymptomatic/mild symptomatic intra-cranial tuberculomas.
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Affiliation(s)
- Manish Jaiswal
- Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Ashok Gandhi
- Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Devendra Purohit
- Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Radhey Shyam Mittal
- Department of Neurosurgery, SMS Medical College and Hospital, Jaipur, Rajasthan, India
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'Precipitation sign': a new radiological sign for spinal intramedullary tubercular abscess. Spinal Cord 2015; 52 Suppl 1:S1-2. [PMID: 24902641 DOI: 10.1038/sc.2014.31] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 02/18/2014] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN We came across two patients with holocord tuberculosis exhibiting similar radiological picture, which may aid in early diagnosis. OBJECTIVES We have described a new radiological sign for early diagnosis of intramedullary tubercular abscess. SETTING Observations from an endemic zone for tuberculosis (India). METHODS Surgical excision followed by histological and microbiological examination and retrospective correlation of clinical-radiological-surgical and pathological picture. RESULTS 'Precipitation sign' can be helpful in the diagnosis of intramedullary tuberculosis. CONCLUSION Presence of an intradural extramedullary mass at the lower end of the spinal cord associated with holocord T2 hyperintensities of the spinal cord can be called as precipitation sign and should raise the suspicion of intramedullary tubercular abscess.
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Abstract
Background:Intravascular large cell lymphoma (ILCL) is a diagnostic challenge, with neurological, cutaneous and constitutional symptoms. The natural history is usually an evolution to a comatose state. As invasive procedures are usually required for diagnosis, recognizing the typical clinical pattern is critical since an effective treatment is available.Method:After an extensive literature review of the subject, we report a case of ILCL, analyzing clinical, laboratory, radiological and pathological data. We will also give a special attention to the clinical picture of a conus medullaris (CM) lesion with subsequent encephalopathy in the same patient.Results:We report here a 61-year-old woman with a paraplegia caused by a CM lesion, evolving about one year latter to encephalopathy and eventual coma, with the diagnosis of ILCL confirmed by autopsy. The present case is similar to eight other cases in literature who had CM lesion associated with ILCL, knowing that 80-90% of these patients will eventually evolve to encephalopathy without treatment. Conclusions: ILCL is a recognized but rare cause of coma. Diagnosing it is tremendously important since it is fatal if left untreated. We propose that this specific picture (conus medullaris lesion, eventually evolving to encephalopathy) is quite characteristic and will directly result in better outcome if recognized.
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8
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An Intramedullary Tuberculous Abscess of the Conus in a 5-Year-Old Child Presenting with Urinary Dysfunction. World Neurosurg 2011; 76:592.e15-8. [DOI: 10.1016/j.wneu.2011.01.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 11/18/2010] [Accepted: 01/26/2011] [Indexed: 11/21/2022]
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9
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Guirado VM, Welling LC, Meluzzi A, Santos MESD, Figueiredo EG, Taricco MA, Teixeira MJ. Intramedullary granuloma suggestive of tuberculoma. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:848-9. [DOI: 10.1590/s0004-282x2011000600028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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10
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Tuberculome du cône médullaire : à propos d’un cas et revue de la littérature. Rev Mal Respir 2011; 28:696-9. [DOI: 10.1016/j.rmr.2011.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 09/26/2010] [Indexed: 11/24/2022]
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Diagnostic et traitement d’un tuberculome intramédullaire : quelle place pour la neurochirurgie ? Presse Med 2011; 40:314-6. [DOI: 10.1016/j.lpm.2010.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Revised: 09/16/2010] [Accepted: 10/15/2010] [Indexed: 11/18/2022] Open
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12
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Jira M, El Qatni M, Sekkach Y, Elomri N, Ghafir D, Zerhouni A, Mounach J. Une paraparésie fébrile. Rev Med Interne 2010; 31:506-7. [DOI: 10.1016/j.revmed.2009.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 08/17/2009] [Indexed: 10/19/2022]
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13
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Tuberculome du cône médullaire : à propos d’un cas et revue de la littérature. Neurochirurgie 2009; 55:561-4. [DOI: 10.1016/j.neuchi.2008.08.110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Accepted: 08/05/2008] [Indexed: 11/23/2022]
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14
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Management of intramedullary spinal cord abscess: experience with four cases, pathophysiology and outcomes. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2009; 18:710-7. [PMID: 19172309 DOI: 10.1007/s00586-009-0885-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2008] [Revised: 12/17/2008] [Accepted: 01/06/2009] [Indexed: 10/21/2022]
Abstract
Intramedullary spinal cord abscess (ISCA) in children is extremely a rare infection of the central nervous system (CNS); and probably a devastating neurological condition. Clinical awareness of patients at risk is crucial for early diagnosis and intervention; as this entity is one of the treatable conditions of paraparesis. Association with congenital neuro-ectodermal abnormality in children is frequent. This pathology highlights the importance of complete neurological checks of infants as a part of their routine physical examination and early management of patients with congenital dermal sinus, prophylactic surgical resection of such a congenital anomaly is recommended by most authors to prevent serious infections of the CNS. However, once the abscess is established; immediate surgical drainage along side adequate antibiotics should be instituted. This may guarantee improving neurological outcome. In this communication, the authors present their experience with four cases of ISCA in children treated successfully with surgical drainage, intravenous antibiotics and neuro rehabilitation between 2001 and 2006 and discuss their results. We concluded that early diagnosis and treatment is essential; before a devastating mechanico-vascular insult of the spinal cord is established from rapid formation of the abscess and a swift expansion of the spinal cord within the limited intraspinal space.
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15
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Ebner FH, Roser F, Acioly MA, Schoeber W, Tatagiba M. Intramedullary lesions of the conus medullaris: differential diagnosis and surgical management. Neurosurg Rev 2008; 32:287-300; discussion 300-1. [PMID: 18820958 DOI: 10.1007/s10143-008-0173-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2008] [Revised: 08/01/2008] [Accepted: 08/19/2008] [Indexed: 10/21/2022]
Abstract
The medullary conus represents a distinct entity of the spinal cord regarding its anatomical, clinical and microsurgical features. An overview of the pathologic processes of this region is provided. Epidemiological, clinical and neuroradiological characteristics of neoplastic (glial tumors, non-glial tumors, metastasis, primary melanomas) and non-neoplastic lesions (granulomatous lesions, abscess, parasitic infections, vascular, demyelinating and dysembryogenetic lesions) are discussed. Main MR imaging characteristics used to differentiate neoplastic from non-neoplastic lesions consist in pathological spinal cord expansion, gadolinium-enhancement and tumoural cyst formation. Management strategies differ substantially, depending on the kind of lesion. According to the suspected pathological entity radical resection, biopsy or conservative treatments are reasonable options. Intraoperative electrophysiological monitoring is a fundamental part of the surgical setting.
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Affiliation(s)
- Florian H Ebner
- Department of Neurosurgery, Eberhard-Karls-University, Tübingen, Germany.
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Park HS, Song YJ. Multiple tuberculoma involving the brain and spinal cord in a patient with miliary pulmonary tuberculosis. J Korean Neurosurg Soc 2008; 44:36-9. [PMID: 19096654 DOI: 10.3340/jkns.2008.44.1.36] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2006] [Accepted: 07/07/2008] [Indexed: 11/27/2022] Open
Abstract
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.
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Affiliation(s)
- Hyun-Seok Park
- Department of Neurosurgery, College of Medicine, Dong-A University, Busan, Korea
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Korri H, Awada A. Tuberculose miliaire et tuberculome intramédullaire du cône terminal. Rev Neurol (Paris) 2007; 163:1106-8. [DOI: 10.1016/s0035-3787(07)74186-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Agrawal A, George P, Kumar S, Shetty J, Shetty RK. TUBERCULAR MENINGITIS WITH CONCURRENT INTRACRANIAL AND INTRA-SPINAL TUBERCULOMAS. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2007. [DOI: 10.29333/ejgm/82491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Skoglund TS, Nilsson D. Tumor of the conus medullaris treated with antituberculous therapy. Clin Neurol Neurosurg 2007; 109:192-4. [PMID: 16962232 DOI: 10.1016/j.clineuro.2006.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2006] [Revised: 07/02/2006] [Accepted: 08/01/2006] [Indexed: 11/20/2022]
Abstract
This case report concerns a 21-year-old man developing left leg paresis. Evaluation with magnetic resonance imaging (MRI) showed an intramedullary tumor in the conus region. He was planned for surgery but preoperative investigation indicated he had tuberculosis and the tumor was presumed to be a tuberculoma. Antituberculous therapy was started and the patient improved neurologically. The patient was followed clinically and with consecutive MRI during 2 years and the last MRI showed that the lesion had disappeared completely. Intramedullary tuberculomas are rare but important differential diagnosis in patients with spinal cord mass lesions. The role of medical and surgical treatment of intramedullary tuberculomas is discussed.
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Affiliation(s)
- Thomas S Skoglund
- Department of Neurosurgery, Sahlgrenska University Hospital, Blå Stråket 7, S-413 45 Göteborg, Sweden.
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Jaiswal AK, Jaiswal S, Gupta SK, Singh Gautam VK, Kumar S. Intramedullary tuberculoma of the conus. J Clin Neurosci 2006; 13:870-2. [PMID: 16931024 DOI: 10.1016/j.jocn.2005.11.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2005] [Accepted: 11/24/2005] [Indexed: 11/21/2022]
Abstract
We present a conus medullaris tuberculoma in a 12-year-old girl. She presented with low backache, weakness of both lower limbs and urinary disturbance. Magnetic resonance imaging revealed a D10-L1 intramedullary mass. The tumour was excised and the biopsy was suggestive of tuberculoma. The patient received antituberculous therapy postoperatively and improved. The relevant literature is discussed briefly.
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21
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Muthukumar N, Venkatesh G, Senthilbabu S, Rajbaskar R. Surgery for intramedullary tuberculoma of the spinal cord: report of 2 cases. ACTA ACUST UNITED AC 2006; 66:69-74; discussion 74. [PMID: 16793447 DOI: 10.1016/j.surneu.2005.10.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2005] [Accepted: 10/22/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Intramedullary tuberculomas are rare. With the widespread availability of MRI and the increasing incidence of HIV and HIV-related tuberculous infections, the incidence of these lesions is likely to increase worldwide. The role of medical and surgical treatment of these relatively rare lesions remains to be defined. We report 2 patients who presented with intramedullary tuberculomas and discuss the importance of early surgery in this condition. CASE DESCRIPTION Two female patients presented with insidious onset of myelopathy. The first patient had seizures due to imaging-documented intracranial tuberculomata and progressive paraparesis due to an intramedullary tuberculoma. The second patient had also had insidious onset of myelopathy and evidence of an intramedullary tuberculoma in MRI. She was also found to have abdominal and pulmonary tuberculosis. In view of the presence of tuberculosis elsewhere in the body in both the patients and the classical imaging features of intramedullary tuberculoma, they were treated initially with antituberculous chemotherapy. However, despite chemotherapy, both patients did not show improvement. Subsequently, both patients underwent microsurgical removal of the intramedullary lesions. The first patient who was neurologically well preserved at the time of surgery improved, whereas the second patient who was paraplegic with sphincter disturbances did not show any improvement. CONCLUSIONS These case reports are presented to highlight the role of early surgery in patients with profound neurological deficits and intramedullary tuberculoma even if the radiological appearance of the lesion is characteristic. Even in lesions that are potentially curable by chemotherapy, early surgery has an important role in the treatment.
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Pike J, Steinbok P, Reilly CW. Cervical intramedullary tuberculoma and tuberculous kyphosis in a 23-month-old child: case report. Can J Surg 2005; 48:247-50. [PMID: 16013633 PMCID: PMC3211551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023] Open
Affiliation(s)
- Jeffery Pike
- Department of Orthopaedics, University of British Columbia, Vancouver
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Mellado JM, Pérez del Palomar L, Camins A, Salvadó E, Ramos A, Saurí A. MR imaging of spinal infection: atypical features, interpretative pitfalls and potential mimickers. Eur Radiol 2004; 14:1980-9. [PMID: 15069578 DOI: 10.1007/s00330-004-2310-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The wide variability of MR features in spinal infection reflects rare distribution of discovertebral involvement, unexpected soft-tissue and bone abnormalities, un-usual complications or uncommon pathogens. In addition, several de-generative and inflammatory entities can clinically and radiologically resemble spinal infection. In this pictorial review, we illustrate the various atypical features that may be found in MR imaging of spinal infection,with emphasis on interpretative pit-falls and common mimickers.
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Affiliation(s)
- José M Mellado
- Institut de Diagnóstic per la Imatge, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.
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Sharma MC, Arora R, Deol PS, Mahapatra AK, Sinha AK, Sarkar C. Intramedullary tuberculoma of the spinal cord: a series of 10 cases. Clin Neurol Neurosurg 2002; 104:279-84. [PMID: 12140088 DOI: 10.1016/s0303-8467(01)00196-2] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Involvement of vertebral column is common in tuberculosis but intramedullary tuberculomas are rare. We report a series of ten cases of intramedullary tuberculomas, which, to the best of our knowledge, is the largest series of biopsy proven intramedullary tuberculomas in English literature. METHODS During a period of 16 years (1985-2000), ten cases of intramedullary tuberculomas were diagnosed in our department. Of these, eight cases were histologically proven intramedullary tuberculomas. The clinical profile, radiological data and histological slides were reviewed. RESULTS Age ranged from 18 to 45 years (mean 29.7 years) and there was slight male preponderance (six men, four women). Duration of symptom varied from 3 to 20 months (mean 11.5 months). All of them presented with motor weakness and sensory impairment. Most common site of involvement was dorsal cord followed by cervical, cervicodorsal and dorsolumbar regions. Three patients had associated involvement of lungs, cervical lymphnodes, and brain, and one patient had past history of tuberculous meningitis. Two patients were treated conservatively but surgical excision was done in eight cases followed by medical treatment. CONCLUSION Radiologically, intramedullary tuberculomas should be differentiated from other space occupying lesions (SOL) to avoid unnecessary surgery especially in those patients with tuberculosis of the other organs. The incidence of intramedullary tuberculomas is likely to increase with a rise in the incidence of AIDS.
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Affiliation(s)
- M C Sharma
- Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, 110 029, New Delhi, India
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Kemaloğlu S, Gür A, Nas K, Cevik R, Büyükbayram H, Saraç AJ. Intramedullary tuberculoma of the conus medullaris: case report and review of the literature. Spinal Cord 2001; 39:498-501. [PMID: 11571663 DOI: 10.1038/sj.sc.3101187] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To illustrate the dilemmas in the diagnosis and management of intramedullary tuberculomas of the spinal cord. METHODS Case report of a 32 year-old man with tuberculous meningitis. The presence of unexplained urinary retention and progressive weakness in the legs led to the discovery of an additional tuberculoma of the conus medullaris. SETTING Dicle University Diyarbakir, Turkey. RESULTS The patient was on a 1-year course of isoniazid, pyrazinamide and rifampicin, and responded well to conservative treatment. Our patient's unique features were represented by the worsening of neurological symptoms while being treated with adequate anti-tuberculous medication. CONCLUSION We present a case of intramedullary tuberculoma of the conus medullaris to illustrate the dilemmas in the diagnosis and management of this curable disease, and review of the literature to date.
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Affiliation(s)
- S Kemaloğlu
- Department of Neurosurgery, School of Medicine, Dicle University, 21100 Diyarbakir, Turkey
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Campo C, Navarro V, Mota JA, Lacruz J, Santos M. [Spinal cord lesion in a patient with human immunodeficiency virus infection]. Enferm Infecc Microbiol Clin 2001; 19:31-3. [PMID: 11256246 DOI: 10.1016/s0213-005x(01)72546-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- C Campo
- Unidad de Enfermedades Infecciosas, Hospital Universitario La Fe, Avda. de Campanar, 21, 46009 Valencia
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Kayaoglu CR, Tuzun Y, Boga Z, Erdogan F, Gorguner M, Aydin IH. Intramedullary spinal tuberculoma: a case report. Spine (Phila Pa 1976) 2000; 25:2265-8. [PMID: 10973413 DOI: 10.1097/00007632-200009010-00020] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case report showing an intramedullary thoracic spinal tuberculoma secondary to pulmonary tuberculosis in a 16-year-old patient with findings of subacute spinal cord compression. OBJECTIVES The significance and the use of magnetic resonance imaging in the diagnosis of intramedullary tuberculoma, and the treatment of the patient that involves surgically the excision of intramedullary lesion followed by appropriate antituberculous therapy. SUMMARY OF BACKGROUND DATA Tuberculomas of spinal cord are rare entities. The possibility of intramedullary tuberculoma should be seriously considered when an intraspinal mass is found, provided that pulmonary tuberculosis is present in the history of the patient. METHOD Th4-Th5 laminectomy was performed. Intramedullary tuberculoma was excised through a myelotomy. Antituberculous treatment was applied after the surgery. RESULTS Excellent clinical outcome was obtained with a combination of both medical and surgical treatments. CONCLUSION The intramedullary spinal tuberculoma, although a rare entity, must be considered in the differential diagnosis of the spinal cord compression in patients with a history of tuberculosis, human immunodeficiency virus, and those who have a bad socioeconomic condition and bad nutrition habit. When confronted with a progressing neurologic deficit, a combination of microsurgical resection and antituberculous chemotherapy with the avoidance of steroids should be the choice of treatment for intramedullary tuberculomas.
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Affiliation(s)
- C R Kayaoglu
- Department of Neurosurgery, School of Medicine, Ataturk University, Erzurum, Turkey
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Kim WU, Lee SH, Shim BY, Min JK, Hong YS, Park SH, Cho CS, Park CK, Kim HY. Intramedullary tuberculosis manifested as Brown-Sequard syndrome in a patient with systemic lupus erythematosus. Lupus 2000; 9:147-50. [PMID: 10787014 DOI: 10.1191/096120300678828064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 25-year-old girl presented with progressive deterioration of right side weakness with decreased sensation on the left trunk. She had been treated with high dose steroid due to autoimmune thrombocytopenia for 2 months. Clinical, laboratory and immunologic studies revealed that she had systemic lupus erythematosus (SLE), MRI of spinal cord showed marginal contrast enhancing and fluid containing mass in the cord of the C5-6 level, suggesting intramedullary abscess. She underwent surgery of mass removal with biopsy. The pathologic findings from cord tissues revealed numerous acid fast bacilli (AFB) in necrotic tissues. After surgery and anti-tuberculous treatment, her neurologic symptoms were markedly improved with restoration of right side motor weakness. To our knowledge, this is the first case report of intramedullary tuberculosis in a patient with SLE. Since intramedullary tuberculosis may sometimes mimic neurologic complication of SLE itself, it may pose diagnostic and therapeutic confusion for clinicians. We report a case of spinal cord tuberculosis affecting C5, 6 level which was manifested as Brown-Sequard syndrome in a patient with SLE.
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Affiliation(s)
- W U Kim
- Research Center in Catholic Medical Center, Kang-Nam St. Mary's Hospital, Department of Internal Medicine, Seoul, Korea
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Süzer T, Coskun E, Tahta K. Intramedullary spinal tuberculoma. J Neurosurg 2000; 92:124. [PMID: 10616073 DOI: 10.3171/spi.2000.92.1.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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