Concurrent multiple intracranial and intramedullary conus tuberculoma: A rare case report

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.

Intramedullary Conus Medullaris Tuberculoma: A Case Report and Review of the Literature

“…Isolated without the involvement of overlying bone and meninges is rare, and the most common site of involvement is the thoracic part. Intramedullary tuberculoma of the conus medullaris is extremely rare, and to our knowledge, only about 14 cases have been reported to date in the English literature [ 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Table 1 summarized the clinical manifestations and outcomes of these cases, including the present case.…”

Intracranial and Spinal Tuberculosis: A Rare Entity

“…In the acute phase, symptoms of intramedullary spinal tuberculoma may predominate. MRI of the brain should be performed in all such cases so that prompt treatment can be initiated to prevent complications such as seizures and intracranial hypertension [ 7 ].…”

Coexisting spinal intramedullary and intracranial tuberculomas in an immunocompetent child

“…No evidence of extra-neural TB or immunosuppression was reported, indicating it as a primary neurotuberculosis in an immunocompetent patient. Eleven adult[1011121314151617181920] and five pediatric[34567] cases (≤12 years) of coexisting intracranial and intraspinal tuberculoma were reported in the literature [Table 1]. The age and clinical presentation of compressive myelopathy alone in our patient was similar to the cases reported by Thacker and Puri[4] and by Bansal et al [6] The cases presented by Krishnan et al [3] and Chitre et al [5] had features of compressive myelopathy and intracranial symptoms.…”

“…[45] The MRI is a sensitive, noninvasive tool for accurate localization and diagnosis of tuberculoma, thus avoiding the need for an invasive procedure such as biopsy or open surgery. [5202122] The radiological differential diagnosis of intramedullary spinal tuberculoma or lesion apart from tuberculoma would be neurocysticercosis, glioma, ependymoma, fungal infections, toxoplasmosis, and lymphoma. However, these lesions are common in adult population.…”

“…[5] Patients with profound neurological deficits require early surgical decompression as a delay can cause irreversible damage to the spinal cord, leaving permanent neurological sequelae. [20]…”