Neuroimaging of Tuberculous Myelitis: Analysis of Ten Cases and Review of Literature

Abstract

We retrospectively reviewed the clinical and neuroimaging features of 10 patients with tuberculous myelitis. The most common presenting symptoms were fever (70%) and paraplegia (60%). Bladder and bowel symptoms were present in 90% patients. On MRI, the involvement of the cervical/thoracic segment of the spinal cord was most commonly seen (90%). The most consistent finding was hyperintense signals on T2-weighted MRI. T1-weighted images showed isointense (n= 5) and hypointense (n= 4) signals in the spinal cord lesions. Post-contrast enhancement was present in 6 patients, epidural enhancement in 4 patients, and cord swelling in 2 patients. We reviewed more than 250 published cases with the diagnosis of tuberculous myelitis and radiculomyelitis with special attention to MRI findings. It is predominantly a disease of the thoracic spinal cord. Most spinal cord lesions appear as hyperintense on T2 and iso- or hypointense on T1-weighted images. MRI findings in patients with spinal cord tuberculosis have both diagnostic and prognostic significance. Cord atrophy or cavitation and the presence of syrinx on MRI may be associated with poor outcome.

British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children

“…101 Tuberculous radiculomyelitis involves more than one spinal region in >80%, with the thoracic and cervical region being most commonly affected. 102,103 The CSF usually shows increased signal intensity on T1-weighted images, which may be associated with complete loss of the cord-CSF interface and an irregular cord outline. Subarachnoid nodules, clumping of the cauda equine nerve roots, and CSF loculations may also be seen.…”

“…Contrast enhancement may be seen in the meninges (80%), cord (20%), and nerve roots (30%). 102,103 Recommendation The brain of every patient with TBM should be imaged with contrast enhanced CT either before the start of treatment (as part of the diagnostic work-up), or within the first 48 h of treatment (A,II) (Fig. 1).…”

Subdural tuberculous abscess of the lumbar spine in a patient with chronic low back pain

“…Late set of exact diagnosis is the main cause of permanent damage to the high rate and prolonged duration of illness [31][32][33] . Therefore, it is important to know that extensive abstraction of the spinal canal and compression of the spinal cord, in the absence of radiological signs of vertebral infection, indicate spine TB [19][20][21][22][23][24][25] . The authors from the MMA 34 have previously described spinal subdural abscess caused by staphylococcus.…”

“…However, the development of tuberculous abscess in the subdural space of the spine is extremely rare [15][16][17][18] . Despite modern imaging methods, atypical presentations of spinal TB can lead to misdiagnosis and the development of neurological complications, sometimes up to paraplegia 4,6,8,[19][20][21][22][23][24] . We presented an extremely rare case of subdural tuberculous abscess of the lumbar spine, and paraparesis.…”

An evaluation of etiological and radiological profile of patients of non-compressive myelopathy in a neurological institute of Eastern India

“…Post contrast patchy enhancement was present in cord in all the cases with 3 cases showing epidural enhancement ( Figure 5) as well. [11] B12 deficiency was found to be another important cause. This was present in 9 individuals.…”