Intramedullary Tuberculoma of the Spinal Cord

Abstract

A case report of intramedullary tuberculoma is presented. Only one other case of intramedullary tuberculoma has been reported in the North American literature in the last 30 years. It is also unique because it is the only documented case of the paradoxical enlargement of an intramedullary tuberculoma after the initiation of antituberculous chemotherapy. Excellent results were obtained with a combination of medical and surgical management.

Intramedullary tuberculoma of the conus medullaris: case report and review of the literature

“…2,5 Spinal cord involvement is much less common than the brain at a ratio of approximately 1 : 42. 3 This ratio correlates with the spinal cord and brain weight ratio, and their blood supplementation ratio. 3 ± 5 Six conus medullaris tuberculoma cases were reported in English literature up to date 2,5 ± 9 (Table 1).…”

“…4,5 A history of past or concurrent tuberculosis exposure to the disease was often obtainable, and patients had frequently su ered from tuberculous meningitis. 3,11,12 Intracerebral tuberculoma are known to occur quite frequently in association with tuberculous meningitis. 2,4,11,12 Intramedullary tuberculoma, although a rare entity, must be considered in the di erential diagnosis of subacute spinal cord compression, particularly in patients with evidence of extraneural tuberculous disease.…”

“…7,13 The prognosis for neurologic improvement is good with appropriate therapy. 3,12,14 Medical therapy remains the mainstay of treatment, but when confronted with a progressing neurologic de®cit, surgery may be indicated. In the articles reviewed, 3 ± 5,8 ± 10,15 surgery was performed in the majority of patients mainly to establish the diagnosis.…”

“…2 Tuberculoma of the spinal cord is extremely rare, being present in approximately two of every 1000 cases of central nervous system (CNS) tuberculosis. 3 The ratio of cranial to spinal tuberculous is approximately 1 : 42. 4 With the declining incidence of tuberculosis, it is to be expected that the neurological manifestations will become more rare.…”

Intramedullary granuloma suggestive of tuberculoma

“…Wound closure after posterior cranial fossa surgery through the clivus remains a challenge. A multilayer closure was suggested by some authors 1,2 . On the other hand, a multilayer reconstruction may not be achieved in patients with clival defects; in this region, gravity may displace the inlay grafts downwards.…”