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Case Reports
. 2017 Mar 30;3(2):e53-e57.
doi: 10.1055/s-0037-1599823. eCollection 2017 Apr.

Spinal Intramedullary Tuberculosis

Prithvi Varghese  1 , Muhammed Jasim Abdul Jalal  2 , Julio Chacko Kandathil  3 , Iona Leekha Mathew  4
Affiliations
Case Reports

Spinal Intramedullary Tuberculosis

Prithvi Varghese et al. Surg J (N Y). .

Abstract

Tuberculosis of the central nervous system accounts for approximately 1% of all cases of tuberculosis and 50% of these involve the spine. Intramedullary involvement is rare in tuberculosis. Clinical presentation of spinal intramedullary tuberculosis (SIMT) is similar to intramedullary spinal cord tumor. Here, we report the case of a 49-year-old female with dull aching pain of both upper limbs of 1-week duration. On examination, she had no motor deficits. All the deep tendon reflexes were normal. The plantar responses were flexor bilaterally. Cervical spine imaging favored intramedullary tumor. She had partial relief of symptoms with steroid treatment. Repeat imaging done 1 month later revealed mild interval enlargement of the intramedullary lesions and multiple enlarged mediastinal and hilar nodes. Endoscopic ultrasound-guided fine-needle aspiration cytology of mediastinal nodes was suggestive of granulomatous inflammation. Hence, SIMT was considered as the probable diagnosis. The patient was started on antituberculosis therapy.

Keywords: intramedullary; spinal; tuberculoma; tuberculosis.

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Conflict of interest statement

Conflict of Interest The authors have no conflicts of interest relevant to this article to disclose.

Figures

Fig. 1
Fig. 1
Cervical spine sag T2-weighted image showing swollen cervical cord with T2-weighted high-signal edema extending from C3 to C7 levels.
Fig. 2
Fig. 2
( A ) Cervical spine sagittal and ( B ) axial postcontrast T1-weighted fat suppressed images showing enhancing intramedullary cord lesions at C5–C6 level situated in the anterior midline and right anterolateral aspect.
Fig. 3
Fig. 3
( A ) Coronal T1-weighted fat suppressed and ( B ) axial three-dimensional volumetric interpolated breath-hold examination postcontrast images through mediastinum showing extensive mediastinal and hilar adenopathy.
Fig. 4
Fig. 4
( A ) Granuloma cytology. ( B ) Granuloma clot.
Fig. 5
Fig. 5
Cervical spine sag T2-weighted image postantituberculous therapy showing resolution of cord edema.
Fig. 6
Fig. 6
( A ) Cervical spine sagittal and ( B ) axial post contrast T1-weighted fat suppressed images postantituberculous therapy showing ill-defined residual enhancement at the site of C5–C6 level intramedullary lesions.
See this image and copyright information in PMC

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