A rare neurological complication of tuberculosis: Transverse myelitis

Ortega-Rosales, Alberto; Delgado-Torres, Nelson; Burneo-Rosales, Carlos

doi:10.1016/j.idcr.2019.e00564

Cited by 14 publications

(5 citation statements)

References 8 publications

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“…It has been defined as a hyperintense signal on T2-weighted images with spinal cord edema and enlargement and a marginal enhancement on postcontrast MR images (9). In the past, TBM with myelitis has been mostly reported in the form of case reports (6,(10)(11)(12)(13)(14). In these case reports, a total of 15 patients had been diagnosed with TBM-related myelitis.…”

Section: Introductionmentioning

confidence: 99%

Myelitis: A Common Complication of Tuberculous Meningitis Predicting Poor Outcome

Jiang

Guo

et al. 2022

Front. Neurol.

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BackgroundMyelitis is an important complication in patients with tuberculous meningitis (TBM). However, a paucity of publications exists on the spectrum of neurological and MRI findings of TBM-related myelitis. The risk factors and prognosis of myelitis in patients with TBM are not fully understood. Therefore, this study aims to identify the risk factors, clinicoradiological features, and prognostic impact of myelitis for patients with TBM.MethodsWe conducted a retrospective study in our institution. Patients with TBM who were consecutively admitted during the period of August 2015 to December 2019 were included. We reviewed the demographic characteristics, clinical, laboratory and MRI findings, and clinical outcomes of all of the included patients. The diagnosis of myelitis was identified by a hyperintensity on T2-weighted images that were associated with cord edema, enlargement, and marginal or no enhancement on contrast-enhanced images.ResultsA total of 114 patients were included. Myelitis occurred in 19 (16.7%) patients, five of whom paradoxically developed myelitis. The common clinical signs of myelitis were paraparesis (738.9%), quadriparesis (844.4%), urinary retention or constipation (1,477.8%), and paresthesias in the lower limbs (1,052.6%). In the MRI findings, the hyperintensities on T2-weighted images involved more than 3 spinal cord segments. Myelitis was often combined with other forms of spinal cord injury, including 10 patients (52.6%) with spinal meningeal enhancement, 7 patients (36.8%) with enlargement of the central canal of the spinal cord, 6 patients (31.6%) with tuberculoma, and 4 patients (21.1%) with arachnoiditis and 1 patient (5.3%) with cerebrospinal fluid (CSF) loculations. None of the 5 patients with paradoxical myelitis were complicated with spinal meningeal enhancement and arachnoiditis, while 4 patients were complicated with enlargements of the central canal of the spinal cord. In multivariable analysis, a grade III disease severity on admission [p = 0.003, odds ratio (OR) = 8.131, 95% CI: 2.080–31.779] and high CSF protein (p = 0.033, OR = 1.698, 95% CI: 1.043–2.763) were independent risk factors for myelitis. After the 6 months follow-up, myelitis (p = 0.030, OR = 13.297, 95% CI: 1.283–137.812) and disturbance of consciousness (p = 0.042, OR = 12.625, 95% CI: 1.092–145.903) were independent risk factors for poor outcomes.ConclusionMyelitis was a common complication of TBM and independently predicted a poor outcome. A grade III disease severity and high CSF protein on admission were independent risk factors for myelitis. Paradoxical myelitis was rarely complicated with spinal meningeal enhancements and arachnoiditis, indicating that the immune reaction may play a dominant role.

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Section: Introductionmentioning

confidence: 99%

Myelitis: A Common Complication of Tuberculous Meningitis Predicting Poor Outcome

Jiang

Guo

et al. 2022

Front. Neurol.

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“…Tubercular myelitis may have an acute or sub-acute presentation. There are other reports available on longitudinal extensive transverse myelitis related to tuberculosis infection (3,5). Our case was presented with paraparesis or paraplegia, radicular pain and neurogenic bladder.…”

Section: Case Presentationmentioning

confidence: 64%

Central Nervous System Tuberculosis Presenting As a Case of Myelitis: A Rare Complication

Mohanty

Panda

2021

jcbr

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Background: Transverse myelitis is an inflammatory disorder of the spinal cord manifested by acute or subacute onset of paraparesis, sensory deficit and autonomic dysfunction. Mycobacterium tuberculosis is a very rare cause of transverse myelitis. Diagnosis is made through clinical examination, cerebrospinal fluid analysis, magnetic resonance imaging (MRI) of spinal cord and bacteriological confirmation of infection. We report a case of tuberculoma presenting as transverse myelitis. Case description: A 21 years old female presented with hypotonia of lower limbs, urine retention, no abdominal reflex and no deep tendon reflex in knee and ankle. Brain and spine MRI suggested multi tuberculomas and incomplete myelitis. The patient was recovered after treatment with antitubercular drugs and corticosteroids. Conclusion: Our findings highlight the importance of considering tuberculosis infection when managing cases with longitudinal extensive transverse myelitis.

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“…In the presence of active TB infection, the patient displayed an abnormal Babinski sign and had strength of 0/5 for the lower extremities. 12 One paper compiled 4 case presentations for patients experiencing TB-associated symptoms, all with abnormal cerebrospinal fluid findings. While the case presentations were varied, especially with regard to DTR, all 4 cases displayed limb strength of 0/5 for the limbs in question.…”

Section: Discussionmentioning

confidence: 99%

Transverse myelitis after Johnson & Johnson COVID-19 vaccine: illustrative case

Mathew

Williamson

Mamo

et al. 2022

Journal of Neurosurgery: Case Lessons

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BACKGROUND Transverse myelitis is a rare neurological occurrence with varied presentation. Imaging is necessary to properly diagnose this condition; however, identifying the cause of this condition may often be difficult. OBSERVATIONS An otherwise healthy patient presented to the clinic with peculiar neurological symptoms without an obvious underlying cause. Imaging evidenced no significant structural defects but did lead to discovery of cord enhancement compatible with a diagnosis of transverse myelitis. Corticosteroid treatment was initiated rapidly to address this pathology, and the patient recovered without deficits. To identify the underlying cause, patient medical history was reviewed thoroughly and compared with existing literature. Previous tuberculosis infection could be a less likely cause of the neurological symptoms. However, recent vaccination with the Johnson & Johnson coronavirus disease 2019 (COVID-19) vaccine could be a more likely cause of the transverse myelitis, which has been rarely reported. LESSONS Transverse myelitis after COVID-19 infection has been an escalating phenomenon. However, transverse myelitis after COVID-19 vaccination is a rare occurrence that is also on the rise. Given the increased rates of vaccination, transverse myelitis should not be overlooked as a potential pathology, due to the severity of neurological impairment if this condition is not treated rapidly.

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A rare neurological complication of tuberculosis: Transverse myelitis

Cited by 14 publications

References 8 publications

Myelitis: A Common Complication of Tuberculous Meningitis Predicting Poor Outcome

Myelitis: A Common Complication of Tuberculous Meningitis Predicting Poor Outcome

Central Nervous System Tuberculosis Presenting As a Case of Myelitis: A Rare Complication

Transverse myelitis after Johnson & Johnson COVID-19 vaccine: illustrative case

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