Intramedullary tuberculoma: A case report

Maamar, M.; Quessar, A. El; Fatemi, Nizar El; Hassani, M.R. El; Chakir, N.; Jiddane, M.

doi:10.1016/j.radi.2006.04.006

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…[ 2 5 6 7 8 ] However, intramedullary tuberculoma of the conus medullaris is extremely rare, with only about 15 cases reported to date in the English literature to the best of our knowledge, and none reported in our country. [ 1 2 3 4 12 15 16 17 18 19 20 21 22 23 24 ]…”

Section: Discussionmentioning

confidence: 99%

“…Making a clinical diagnosis of conus medullaris IMT, based on the patient’s symptoms is very difficult, because of the varied presentation from the different case report in the literature, as a result a high index of suspicion is required to consider IMT as a differential of conus medullaris tumour. [ 1 2 3 4 12 15 16 17 18 19 20 21 22 23 24 ] Just as it is, in the index patient, where it was difficult to make a clinical diagnosis. Earlier publications and review of literatures, reported that the clinical presentations of these disease, are not distinct from those of any other intramedullary mass lesion of the conus medullaris, thus making a clinical diagnosis a major challenge.…”

Section: Discussionmentioning

confidence: 99%

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Intramedullary tuberculoma of the conus medularis in an immunocompetent young adult with no pulmonary tuberculosis, the challenges of diagnosis and management: A case report and review of literature

Alfin,

Akpa,

Shilong

et al. 2023

J West Afr Coll Surg

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Background and Objective: Intramedullary tuberculoma (IMT) of the conus medullaris is an extremely rare tumour that constitutes a diagnostic and management challenge in a resource-limited setting. We report a case of conus medullaris, IMT in a young immunocompetent, patient with no prior clinical features of pulmonary or extra-pulmonary tuberculosis. Case Summary: The patient presented with six months history of progressive and persistent mid back pain and slight weakness of both lower limbs of 3 months duration. Physical examination revealed a well-nourished man with power of 3/5 and hyperreflexia on both lower limbs. Chest radiograph and other investigations for tuberculosis were negative. Magnetic resonance imaging (MRI) of the lumbosacral spine showed fusiform expansion of the conus medullaris, with a well circumscribed, ring enhancing, intramedullary mass straddle between T12 and L1. Patient had gross total resection with no intraoperative monitoring assistance and no post-operative worsening of neurological function. Histology showed granulomatous lesion with central caseation in keeping with a tuberculoma. Patient was commenced on post-operative anti-tuberculous therapy with physiotherapy, with full motor recovery at six months post-surgical intervention and anti-tuberculous therapy. Conclusion: Intramedullary tuberculoma can be considered as one of the differential diagnoses of intradural, intramedullary tumour of the conus, even in immunocompetent individual with no clinical features of tuberculosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intramedullary tuberculoma of the conus medularis in an immunocompetent young adult with no pulmonary tuberculosis, the challenges of diagnosis and management: A case report and review of literature

Alfin,

Akpa,

Shilong

et al. 2023

J West Afr Coll Surg

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Chotmongkol

Wanitpongpun

Phuttharak

et al. 2021

Infectious Disease Reports

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Intramedullary tuberculoma (IMT) of the conus medullaris is extremely rare. We present a case of intramedullary conus medullaris tuberculoma in which the diagnosis was based on there being very high levels of adenosine deaminase (ADA) in the patient’s cerebrospinal fluid (CSF) and improvement with antituberculous therapy. A 78-year-old man presented after having had a dull ache in both thighs and progressive paraparesis. The patient’s medical history included diffuse large B-cell lymphoma, which had undergone remission due to chemotherapy two years earlier, and long-term, well-controlled diabetes. A chest X-ray showed no evidence of tuberculosis. The results of CSF analysis were compatible with Froin’s syndrome. An initial diagnosis was made of an intramedullary tumor of the conus medullaris, based on magnetic resonance imaging (MRI). A myelotomy and multiple punch out biopsy were performed, and histopathology of the tissues revealed mild reactive gliosis. Due to the patient having high levels of CSF-ADA, IMT of the conus medullaris was suspected. The patient was treated with an 18-month course of antituberculous therapy. The dull ache gradually disappeared, and motor power improved slightly. A follow-up MRI of the lumbosacral (LS) spine revealed that the lesion had completely disappeared. Intramedullary tuberculoma of the conus medullaris should be considered in patients with underlying malignancy and no symptoms of systemic tuberculosis. CSF adenosine deaminase levels can be helpful in determining the presence of central nervous system tuberculosis when other systemic signs of disease are lacking.

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“…Atypical teratoid/rhabdoid tumor is extremely rare, and imaging findings visualized thus far in spinal atypical teratoid/rhabdoid tumor are nonspecific 3,6 ; these cause significant difficulties in the differential diagnosis between inflammatory and infectious diseases and neoplasm. 9 Spinal tuberculomas have a different appearance, [10][11][12] reflecting different stages of the evolution of the lesions. Magnetic resonance imaging shows fusiform enlargement of the cord or cord swelling with ill-defined lesion, isointensity/ hypointensity on T1-weighted images, and isointensity/ hyperintensity or heterogeneous on T2-weighted images with ring enhancement.…”

Section: Atypical Teratoid/rhabdoid Tumor Of the Spine In A 4-year-olmentioning

confidence: 99%

“…Magnetic resonance imaging shows fusiform enlargement of the cord or cord swelling with ill-defined lesion, isointensity/ hypointensity on T1-weighted images, and isointensity/ hyperintensity or heterogeneous on T2-weighted images with ring enhancement. [10][11][12] Intramedullary tuberculoma is most commonly associated with arachnoiditis, which causes significant difficulty to differentiate from intramedullary neoplasm. In our case, differentiating between spinal tuberculoma with arachnoiditis and neoplasm with leptomeningeal dissemination was difficult, especially with the occurrence of hypoglycorrachia on cerebrospinal fluid.…”

Section: Atypical Teratoid/rhabdoid Tumor Of the Spine In A 4-year-olmentioning

confidence: 99%

Atypical Teratoid/Rhabdoid Tumor of the Spine in a 4-Year-Old Girl

et al. 2008

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Intramedullary tuberculoma: A case report

Cited by 5 publications

References 10 publications

Intramedullary tuberculoma of the conus medularis in an immunocompetent young adult with no pulmonary tuberculosis, the challenges of diagnosis and management: A case report and review of literature

Intramedullary tuberculoma of the conus medularis in an immunocompetent young adult with no pulmonary tuberculosis, the challenges of diagnosis and management: A case report and review of literature

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

Atypical Teratoid/Rhabdoid Tumor of the Spine in a 4-Year-Old Girl

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