Syringomyelia - As a Late Complication of Tuberculous Meningitis

Abstract

The aim of this paper is to demonstrate the unusual MR features of thoracic syringomyelia following TB meningitis and to discuss the neurosurgical aspect of the treatment of this rare entity. Four years after a TB meningitis episode, a 30 year-old female patient developed a progressive spastic paraparesis. MR studies revealed multiloculated syrinxes throughout the thoracic cord. She had a syringo-subarachnoid shunt with a silastic "T" tube inserted. On the first postoperative day, she showed a dramatic neurological improvement, but unfortunately her paraparesis progressed to the preoperative level within a month despite diminished size of the syrinxes on the control MRI examination. Two and a half years after the operation the patient complained of having a burning type of central pain, and further deterioration in neurological function. Thoracic spinal MRI examination demonstrated enlarged syringomyelic cavities. At the second operation syringo-peritoneal shunt insertion was performed via right T10-11 hemilaminectomy using a "T" tube. At present, 4 months after the second operation, the patient's neurological examination demonstrated decreased spasticity, and improved strength in the legs compared to the preoperative level. MRI is the first choice of investigation in detecting TB related myelopathy as it provides a greater detail of pathological changes within and around the spinal cord such as syrinx formation and arachnoiditis. The MR findings are also helpful in deciding the management and predicting the outcome. Presence of multifocal loculations and arachnoid adhesions is the likely cause of treatment failures and poor prognosis.

Atypical intradural spinal tuberculosis: report of three cases

“…Syringomyelia, which is characterized by abnormal cavitation of the spinal cord is an uncommon and a late complication of spinal TB. [34][35][36][37][38] This pathology had been demonstrated in our case 2 as a late complication of spinal TB.…”

Surgical manifestations of thoracic arachnoid pathology: series of 28 cases

“…2 Tethering of the spinal cord and arachnoid cyst formation have been associated with previous trauma. 1,16,18,34,37 Arachnoiditis has been found to occur as a result of infection (for example, tuberculosis and malarial infections of the meninges), 9,10,20,24,27 and after cranial aneurysmal subarachnoid hemorrhage, with blood settling in the spinal subarachnoid space and causing delayed arachnoiditis. 3,13,23,39 Ionic intrathecal contrast administration is another known cause of thoracic and lumbar arachnoiditis.…”

Cervical and axial dystonia in a patient with syringomyelia

“…There is usually a latent period between the evidence of inflammation and the development of syringomyelic symptoms, which varies between 7 to 28 years. In these cases, arachnoid adhesions and multifocal loculations were often present, which resulted in treatment failures and poor prognosis 5 . We described a rare case of dystonia associated with syringomyelia, highlighting the involvement of spinal cord lesions in the genesis of involuntary movements and reinforcing the importance of obtaining a spinal cord MRI when investigating a case of dystonia with atypical presentation.…”