Intramedullary tuberculoma of conus medullaris: A case report

Abstract

Spinal Intramedullary tuberculoma is a rare occurrence constituting about 0.2% to 0.5% of all central nervous system tuberculomas. It is considered rare even in tuberculosis endemic areas. Mostly affecting young individuals, it is mostly found in thoracic cord. The occurrence of intramedullary tuberculoma in the conus medullaris is even rare. We present a case of a 41-year-old female who presented with symptoms of sudden loss of bowel and bladder function along with saddle anesthesia which later on imaging and biopsy findings was diagnosed to be case of intramedullary tuberculoma of conus medullaris, and was managed with anti-tubercular regimen and corticosteroids.

Keywords: Tuberculoma; anti-tubercular regimen; case report; conus medullaris; endemic region.

Fig. 1

(A) T2 MR image in the mid sagittal section shows a linear long segment hyperintense intramedullary lesion in the conus region with mild expansion of the cord, (B) The T2 hyperintense intramedullary lesion is more conspicuous in the T2-STIR mid-sagittal MR image, and (C) In this T2-STIR coronal image, there is mild expansion of the conus by the T2 hyperintense lesion. The cauda equina nerve roots are thickened.

Fig. 2

T1 fat saturated post contrast coronal MR image showing the heterogenous enhancement of the intramedullary lesion compared to T1 non-contrast image (Not shown). There is enhancement of the cauda equina nerve roots with their thickening.

Fig. 3

(A,B,C) Histopathological examination (with Hematoxylin and Eosin stain) of arachnoid sample revealing thickened arachnoid with infiltration of lymphocytes with few epithelioid cell granulomas along with Langhans type giant cell. Examination of the lesion showed fragments of glial tissue with aggregates of lymphocytes and a few epithelioid cell granulomas, without visualization of necrosis.