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Jesrani G, Kaur J, Gupta M, Sawal N. Syringomyelia as a delayed complication of lumbar-sacral adhesive arachnoiditis in Pott's disease. BMJ Case Rep 2020; 13:13/5/e234032. [PMID: 32467119 DOI: 10.1136/bcr-2019-234032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Syringomyelia is the development of a fluid-filled cyst (syrinx) within the spinal cord and is an extremely rare chronic manifestation of tuberculosis. The syrinx so formed may expand over time, causing compression or destruction of spinal tracts and surrounding nerve roots. Development of syringomyelia in a patient of Pott's disease is particularly infrequent. We report this rare case of a 31-year-old man with syringomyelia as a prolonged complication of Pott's disease.
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Affiliation(s)
- Gautam Jesrani
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Jaspreet Kaur
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Monica Gupta
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Nishit Sawal
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
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Bhatnagar N, Kataria A, Lingaiah P, Karkhur Y. Tetraplegia associated with post-operative syringomyelia in spinal tuberculosis: a result of an epidural compartment syndrome? Spinal Cord Ser Cases 2019; 5:18. [PMID: 30774988 DOI: 10.1038/s41394-019-0159-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/06/2019] [Accepted: 01/13/2019] [Indexed: 11/09/2022] Open
Abstract
Introduction The commonly recognized causes of post-operative neurological deterioration in spinal tuberculosis are inadequate decompression, damage to vascular supply of the spinal cord, and multi-drug resistant organisms. There are no known cases of syringomyelia developing after surgical decompression of spinal tuberculosis. Case presentation A teenage girl presented with rapid onset quadriparesis secondary to a tubercular epidural abscess extending from C4-T8. The neurological status deteriorated to quadriplegia immediately following decompression by hemilaminectomy at C7 and T7 levels. Investigations into the cause of neurological deterioration revealed syrinx formation at T5-9 levels. The patient had partial motor and sensory recovery in the first 3 weeks post-operatively. Tubercular infection was treated with a 1-year course of multi-drug anti-tubercular therapy. However, there was no further neurological improvement at 2 years follow-up. Discussion Syringomyelia in tuberculosis has been associated with tubercular meningitis, intradural tuberculomas, and post-surgical vascular insult. None of these were implicated as the cause of syrinx formation in this case. We hypothesize that the rapid evolution of epidural abscess in an intact vertebral column led to an acute "epidural compartment syndrome", which caused ischemic damage to the spinal cord. Compression caused by the epidural abscess was relieved by surgical decompression, allowing the central canal to dilate and expand into the softened spinal parenchyma, hence leading to syrinx formation.
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Affiliation(s)
- Nishit Bhatnagar
- Department of Orthopaedics, Lilavati Hospital and Research Center, Mumbai, Maharashtra, India.
| | - Ankit Kataria
- Department of Orthopaedics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | | | - Yugal Karkhur
- Department of Orthopaedics, Max Smart Super Specialty Hospital, New Delhi, India
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Marais S, Roos I, Mitha A, Patel V, Bhigjee AI. Posttubercular syringomyelia in HIV-infected patients: A report of 10 cases and literature review. J Neurol Sci 2018; 395:54-61. [PMID: 30292964 DOI: 10.1016/j.jns.2018.09.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/03/2018] [Accepted: 09/26/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To describe the clinical presentation, spinal magnetic resonance imaging (MRI) findings and outcome of HIV-infected patients with tuberculosis (TB)-associated syringomyelia and to compare these findings between all HIV-infected and -uninfected cases published in the literature. METHODS A retrospective observational study conducted over a 12.5-year period at a public-sector referral hospital in South Africa. HIV-infected adults with neurological TB in whom MRI confirmed a syrinx were included. We searched PubMed to identify all published syringomyelia cases. RESULTS Ten patients were enrolled. Syringomyelia complicated neurological TB within four years of initial diagnosis in all patients (median: 21 months, range: 0-39) after initial diagnosis. Six patients were treated conservatively (TB treatment = 5, no treatment = 1); four improved, but only one was ambulant during follow-up. Four patients underwent syringoperitoneal shunting; three improved and one died three months later. Our literature review identified 50 additional cases (HIV-infected = 2, HIV-uninfected = 9, HIV status not documented = 39 [presumed HIV-uninfected]). Clinical and imaging findings and outcomes were similar between HIV-infected and -uninfected cases, except for time of presentation following neurological TB diagnosis, which was delayed (>4 years) in 46% of HIV-uninfected cases, compared to 8% of HIV-infected cases. Conclusions Syringomyelia is a disabling complication of neurological TB that usually presents early after neurological TB diagnosis in HIV coinfected patients.
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Affiliation(s)
- Suzaan Marais
- Department of Neurology, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, 800 Vusi Mzimela Road, Durban 4901, South Africa.
| | - Izanne Roos
- Department of Neurology, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, 800 Vusi Mzimela Road, Durban 4901, South Africa
| | - Ayesha Mitha
- Department of Radiology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Vinod Patel
- Department of Neurology, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, 800 Vusi Mzimela Road, Durban 4901, South Africa
| | - Ahmed I Bhigjee
- Department of Neurology, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, 800 Vusi Mzimela Road, Durban 4901, South Africa
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Jawad N, Jafri S, Naqvi S, Ahmad SM, Naveed S, Ali Z. A Case Report on Complicated Tuberculous Meningitis. Cureus 2017; 9:e1222. [PMID: 28589071 PMCID: PMC5453745 DOI: 10.7759/cureus.1222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Tuberculous meningitis (TBM) is associated with significant complications of central nervous system. It is accompanied by nonspecific and heterogeneous clinical symptoms. We focused on the significance of early diagnosis and prompt treatment. We describe a case of TBM in a 19-year-old Asian female. She had a progressive motor weakness with no sensory findings. She was started on antituberculous therapy. Her magnetic resonance imaging (MRI) contrast of dorsolumbar spine showed syringomyelia. Her culture and sensitivity for Mycobacterium tuberculosis (MTB) came negative. She was given a therapeutic trial of quinolones and Steroids. She had an uneventful recovery and was followed up for the past one year.
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Affiliation(s)
- Nadia Jawad
- Chest Medicine, Jinnah Postgraduate Medical Center Karachi Pakistan
| | - Saira Jafri
- Pulmonology, Jinnah Postgraduate Medical Center Karachi Pakistan
| | - Syeda Naqvi
- Jinnah Postgraduate Medical Centre, Jinnah Sindh Medical University (SMC)
| | | | - Shabnam Naveed
- Department of Medicine, Jinnah Postgraduate Medical Center Karachi Pakistan
| | - Zeeshan Ali
- Jinnah Postgrduate Medical Centre, Jinnah Sindh Medical University (SMC)
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Lee JS, Song GS, Son DW. Surgical Management of Syringomyelia Associated with Spinal Adhesive Arachnoiditis, a Late Complication of Tuberculous Meningitis: A Case Report. Korean J Neurotrauma 2017; 13:34-38. [PMID: 28512616 PMCID: PMC5432447 DOI: 10.13004/kjnt.2017.13.1.34] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 11/21/2016] [Accepted: 11/24/2016] [Indexed: 12/24/2022] Open
Abstract
Syringomyelia associated with tuberculous meningitis is an extremely rare condition. Only a few studies have reported clinical experience with syringomyelia as a late complication of tuberculous meningitis. Twenty-six years after a tuberculous meningitis episode, a 44-year-old man presented with progressively worsening spastic paresis of the lower limbs and impaired urinary function for 2 years. Radiological examination revealed syringomyelia extending from the level of C2 to T9 and arachnoiditis with atrophy of the spinal cord between C2 and T3. We performed laminectomy from C7 to T1, dissected the arachnoid adhesion and placed a syringo-pleural shunt via keyhole myelotomy. One year after the operation, his neurological condition improved. The postoperative control magnetic resonance imaging revealed the correctly located shunt and significantly diminished syringomyelia cavities. We aim to discuss the mechanism of syrinx formation following tuberculous meningitis and to share our surgical therapeutic experience with this rare disease entity.
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Affiliation(s)
- Jun Seok Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea
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Canova G, Boaro A, Giordan E, Longatti P. Treatment of Posttubercular Syringomyelia Not Responsive to Antitubercular Therapy: Case Report and Review of Literature. J Neurol Surg Rep 2017; 78:e59-e67. [PMID: 28428929 PMCID: PMC5393916 DOI: 10.1055/s-0037-1601327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Posttubercular adhesive arachnoiditis is a rare, late complication of tubercular meningitis. Syringomyelia can develop as a consequence of intramedullary cystic lesions and cerebrospinal fluid (CSF) flow disturbance around the spinal cord, even after successful chemotherapy. We reviewed the literature related to posttubercular syringomyelia treatment and suggest a new combined surgical approach. A 25-year-old Nigerian male patient presented with legs numbness, urinary disturbance, and legs weakness. Spinal magnetic resonance revealed a T5-T7 syringomyelia, secondary to adhesive spinal arachnoiditis related to a history of tuberculous meningitis. Adhesiolysis by direct visualization with a flexible endoscope was performed and a handmade S-italic syringe-subdural shunt was placed to restore CSF flow. During the postoperative course, the neurological deficits improved together with the resolution of the syrinx. Long-term magnetic resonance imaging follow-up documented no recurrences or shunt displacements. We suggest that, when antitubercular therapy is not effective to resolve postarachnoiditis syrinx, arachnolysis with a flexible endoscope together with the placement of an S-italic shunt allowed free CSF communication between the syrinx and the subarachnoid space. Furthermore, we support that the use of an s-shaped shunt could prevent displacement or migration of the device and allows an easier revision in case of acute or late complications.
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Affiliation(s)
- Giuseppe Canova
- Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, Italy
| | - Alessandro Boaro
- Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, Italy
| | - Enrico Giordan
- Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, Italy
| | - Pierluigi Longatti
- Department of Neurosurgery, University of Padova, Treviso Regional Hospital, Treviso, Italy
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Tuberculosis - 'The great masquerader' presenting as a dumb-bell-shaped intradural extramedullary tumor in a 20-year-old female. J Clin Orthop Trauma 2017; 8:168-170. [PMID: 28720995 PMCID: PMC5498742 DOI: 10.1016/j.jcot.2016.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/23/2016] [Accepted: 06/14/2016] [Indexed: 11/21/2022] Open
Abstract
Tuberculosis has been known as the great masquerader for its varied presentations. We present an extraordinary case of a 20-year-old female who presented with paraparesis of two months. MRI showed an intradural, extramedullary dumb-bell-shaped, spinal cord tumor. With a provisional clinicoradiological diagnosis of benign nerve sheath tumor (schwannoma/neurofibroma), laminectomy was done. But after durotomy, frank pus was drained from the site of lesion and the laboratory investigations of the tissue and pus obtained proved it to be tubercular. This is a rare case reported in the literature where tuberculosis is mimicking as a dumb-bell-shaped, spinal cord tumor.
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Jeong DK, Kwon YM. Intradural Extramedullary Tuberculoma of the Spinal Cord Following Tuberculous Meningitis. KOREAN JOURNAL OF SPINE 2015. [PMID: 26217394 PMCID: PMC4513166 DOI: 10.14245/kjs.2015.12.2.107] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Intradural extramedullary tuberculoma of the spinal cord (IETSC) is an uncommon disease which can occurs secondary to tuberculous meningitis. A 31-year-old woman was diagnosed as tuberculous meningitis after mental disorientation. Her mentality was recovered after antituberculous therapy. After 7 months of antituberculous therapy, paraplegia has developed. Magnetic resonance imaging (MRI) revealed a mass lesion between the T1 and T12 spinal levels with arachnoid thickening which results in the development of tuberculoma. She received surgical resection of IETSC followed by antituberculous therapy and neurological function has been improved. The two years after surgical treatment, spinal MRI showed syringomyelia between T1 to L1. But, her neurological outcome was not aggravated.
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Affiliation(s)
- Deok-Ki Jeong
- Department of Neurosurgery, Dong-A University College of Medicine, Busan, Korea
| | - Young-Min Kwon
- Department of Neurosurgery, Dong-A University College of Medicine, Busan, Korea
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Sharma B, Nagpal K, Handa R, Gupta P. Intradural extramedullary and intracranial tuberculomas with concurrent communicating syringomyelia. BMJ Case Rep 2014; 2014:bcr-2013-201368. [PMID: 24495974 DOI: 10.1136/bcr-2013-201368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Tuberculosis is the most common chronic central nervous system infection in developing countries like India. Non-osseous spinal cord involvement is a rare manifestation of tuberculosis. The use of MRI, as an imaging modality of choice, has revolutionised the imaging of tuberculomas with reasonable certainty and thereby avoiding unnecessary surgical intervention. We report an unusual presentation of intradural extramedullary and intracranial tuberculomas with communicating syringomyelia complicated with tubercular meningitis.
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Affiliation(s)
- Bhawna Sharma
- Department of Neurology, S.M.S Medical College, Jaipur, Rajasthan, India
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Sundaram SS, Vijeratnam D, Mani R, Gibson D, Chauhan AJ. Tuberculous syringomyelia in an HIV-infected patient: a case report. Int J STD AIDS 2012; 23:140-2. [DOI: 10.1258/ijsa.2011.011104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 37-year-old HIV-positive Gambian woman presented with spastic weakness of the right leg six years after receiving treatment for tuberculous meningitis (TBM). Magnetic resonance imaging (MRI) of the spine showed a multiloculated syrinx in the thoracic spinal cord extending from the T2 to the T11 level. Syringomyelia and syringobulbia have been reported as complications of TBM. We describe the first case of syringomyelia as an uncommon late complication of treated TBM in the setting of HIV infection. Early recognition of this rare entity may avoid irreversible neurological sequelae.
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Affiliation(s)
| | | | - R Mani
- Department of Genitourinary Medicine
| | | | - A J Chauhan
- Respiratory Centre, Portsmouth Hospitals NHS Trust, Portsmouth, UK
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Sohn S, Jin YJ, Kim KJ, Kim HJ. Long-term Sequela of Intradural Extramedullary Tuberculoma in the Thoracic Dorsal Spinal Cord: Case Report and Review of the Literature. KOREAN JOURNAL OF SPINE 2011; 8:295-9. [PMID: 26064149 PMCID: PMC4461743 DOI: 10.14245/kjs.2011.8.4.295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 12/18/2011] [Accepted: 01/06/2012] [Indexed: 11/19/2022]
Abstract
A 45-year old man, who had tuberculosis five years ago presented with paresthesia, decreased proprioception, and gait disturbance in the lower extremity which were aggravated for a month. Magnetic resonance imaging revealed the T3-7 intradural extramedullary fibrotic mass with dark signal intensity on T2-weighted images. The yellowish material in the thick fibrous mass was confirmed as caseous necrosis. Two days after the operation, the symptoms improved. Although quite rare, intradural extramedullary tuberculoma should be considered as a chronic sequel of the previous medical history of pulmonary tuberculosis or tuberculous meningitis.
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Affiliation(s)
- Seil Sohn
- Department of Neurosurgery, Seoul National University College of Medicine, Bundang Hospital, Seongnam-si, Korea
| | - Yong Jun Jin
- Department of Neurosurgery, Seoul Paik Hospital, Inje University, Seoul, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Bundang Hospital, Seongnam-si, Korea
| | - Hyun-Jib Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Bundang Hospital, Seongnam-si, Korea
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Shim DM, Oh SK, Kim TK, Chae SU. Intradural extramedullary tuberculoma mimicking en plaque meningioma. Clin Orthop Surg 2010; 2:260-3. [PMID: 21119945 PMCID: PMC2981785 DOI: 10.4055/cios.2010.2.4.260] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 02/11/2010] [Indexed: 12/03/2022] Open
Abstract
A 24-year-old man with tuberculosis meningitis developed acute paraplegia and sensory disturbances 5 weeks after receiving conventional antituberculous therapy. Magnetic resonance imaging revealed an intradural extramedullary long segmental mass mimicking en plaque meningioma at the T2-T6 vertebrae levels. Prompt surgical decompression was performed. A histology examination of the mass revealed a tuberculoma. After surgery, the patient showed improved motor power and a normal bladder function. Intradural extramedullary tuberculoma of the spinal cord is rare complication of tuberculosis meningitis, which can occur as a response to conventional antituberculous therapy.
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Affiliation(s)
- Dae Moo Shim
- Department of Orthopedic Surgery, Wonkwang University Hospital, Iksan, Korea
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Vaishya R, Singh AP, Singh AP. Arthrodesis in a neuropathic elbow after posttubercular spine syrinx. J Shoulder Elbow Surg 2009; 18:e13-6. [PMID: 19395282 DOI: 10.1016/j.jse.2009.01.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Revised: 01/05/2009] [Accepted: 01/24/2009] [Indexed: 02/01/2023]
Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics, Inderprastha Apollo Hospital, Sarita Vihar, Delhi, India
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