Concurrent Multilevel Spinal Intra-medullary with Extensive Intracranial Tuberculomas: A Rare Case Report

Overview

Journal Asian J Neurosurg

Specialty Neurology

Date 2017 Nov 9

PMID 29114310

Citations 5

Authors

Shyam Sundar Krishnan

Bhavinkumar Rameshchandra Patel

Madabushi Chakravarthy Vasudevan

Affiliations

Soon will be listed here.

Abstract

Disseminated tuberculomas in the brain and spinal cord are rare. To the best of our knowledge, only nine cases of spinal intra-medullary tuberculomas with cranial involvement have been reported till date. However, involvement of all levels in the spinal cord, brain stem with pan lobar involvement of the cerebrum and cerebellum has not been reported so far. We present such a case of a 12-year-old boy with history of pulmonary tuberculosis, who presented with gradual onset of quadriparesis and generalized seizures. We have discussed the unusual clinical presentation and the temporal changes in magnetic resonance imaging features along with clinical response to treatment. In cases reported so far, the plan of surgical versus medical management has been opted for variably, in cases of spinal intra-medullary involvement with acute neurological deficit. The decision is even more difficult in multilevel spinal intra-medullary tuberculomas. Our patient showed good clinico-radiological improvement with medical management.

Citing Articles

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References

Shen W, Cheng T, Lee S, Ho Y, Lee K . Disseminated tuberculomas in spinal cord and brain demonstrated by MRI with gadolinium-DTPA. Neuroradiology. 1993; 35(3):213-5. DOI: 10.1007/BF00588498. View

Thacker M, Puri A . Concurrent intra-medullary and intra-cranial tuberculomas. J Postgrad Med. 2004; 50(2):107-9. View

Wasay M, Kheleani B, Moolani M, Zaheer J, Pui M, Hasan S . Brain CT and MRI findings in 100 consecutive patients with intracranial tuberculoma. J Neuroimaging. 2003; 13(3):240-7. View

Garg R . Diagnostic criteria for neurocysticercosis: some modifications are needed for Indian patients. Neurol India. 2004; 52(2):171-7. View

Del Brutto O, Rajshekhar V, White Jr A, Tsang V, Nash T, Takayanagui O . Proposed diagnostic criteria for neurocysticercosis. Neurology. 2001; 57(2):177-83. PMC: 2912527. DOI: 10.1212/wnl.57.2.177. View

Lim Y, Kim S, Kim M, Lim Y . Disseminated tuberculosis of central nervous system : spinal intramedullary and intracranial tuberculomas. J Korean Neurosurg Soc. 2013; 54(1):61-4. PMC: 3772291. DOI: 10.3340/jkns.2013.54.1.61. View

Park H, Song Y . Multiple tuberculoma involving the brain and spinal cord in a patient with miliary pulmonary tuberculosis. J Korean Neurosurg Soc. 2008; 44(1):36-9. PMC: 2588281. DOI: 10.3340/jkns.2008.44.1.36. View

Gupta R, Pandey R, Khan E, Mittal P, Gujral R, Chhabra D . Intracranial tuberculomas: MRI signal intensity correlation with histopathology and localised proton spectroscopy. Magn Reson Imaging. 1993; 11(3):443-9. DOI: 10.1016/0730-725x(93)90079-s. View

Kim T, Chang K, Kim C, Goo J, Kook M, Han M . Intracranial tuberculoma: comparison of MR with pathologic findings. AJNR Am J Neuroradiol. 1995; 16(9):1903-8. PMC: 8338232. View

10.

MacDonnell A, Baird R, Bronze M . Intramedullary tuberculomas of the spinal cord: case report and review. Rev Infect Dis. 1990; 12(3):432-9. DOI: 10.1093/clinids/12.3.432. View

11.

Muthukumar N, Venkatesh G, Senthilbabu S, Rajbaskar R . Surgery for intramedullary tuberculoma of the spinal cord: report of 2 cases. Surg Neurol. 2006; 66(1):69-74. DOI: 10.1016/j.surneu.2005.10.024. View

12.

Yen H, Lee R, Lin J, Chen H . Multiple tuberculomas in the brain and spinal cord: a case report. Spine (Phila Pa 1976). 2003; 28(23):E499-502. DOI: 10.1097/01.BRS.0000099114.40764.46. View

13.

Shenoy S, Raja A . Concurrent intramedullary and intracerebral tuberculomas. Neurol India. 2005; 52(4):514-6. View

14.

Muthukumar N, Sureshkumar V, Ramesh V . En plaque intradural extramedullary spinal tuberculoma and concurrent intracranial tuberculomas: paradoxical response to antituberculous therapy. Case report. J Neurosurg Spine. 2007; 6(2):169-73. DOI: 10.3171/spi.2007.6.2.169. View

15.

Huang C, Lui C, Chang W, Wu H, Chen H . Neuroimages of disseminated neurotuberculosis: report of one case. Clin Imaging. 2000; 23(4):218-22. DOI: 10.1016/s0899-7071(99)00140-0. View

16.

Chitre P, Tullu M, Sawant H, Ghildiyal R . Co-occurrence of intracerebral tuberculoma with lumbar intramedullary tuberculoma. J Child Neurol. 2009; 24(5):606-9. DOI: 10.1177/0883073808327837. View

17.

Kim M, Kim K, Chung C, Kim H . Intradural extramedullary tuberculoma of the spinal cord: a case report. J Korean Med Sci. 2000; 15(3):368-70. PMC: 3054630. DOI: 10.3346/jkms.2000.15.3.368. View