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Zhou Y, Qin Y, Mu T, Zheng H, Cai J. Magnetic Resonance Imaging Findings of Intraspinal Tuberculoma in Children. Front Neurol 2022; 13:936837. [PMID: 35983432 PMCID: PMC9378988 DOI: 10.3389/fneur.2022.936837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background and PurposeIntraspinal tuberculoma is a rare disease in children, and its imaging findings have been described in only a few case reports. This study aimed to investigate the magnetic resonance imaging (MRI) features of pediatric intraspinal tuberculoma and to explore the possible pathogenesis of the disease.Materials and MethodsThe clinical and MRI data of 24 child patients with intraspinal tuberculoma (such as 6 cases of intramedullary tuberculoma, 8 cases of intradural extramedullary tuberculoma, and 10 cases of epidural tuberculoma) were retrospectively analyzed. All patients underwent plain and contrast-enhanced MR scans. The diagnosis was confirmed by surgical pathology or by antituberculous treatment and follow-up data.ResultsIntramedullary tuberculoma had a round shape, while intradural extramedullary tuberculoma and epidural tuberculoma presented long-fusiform or en plaque shapes. Regarding MRI signals, intramedullary tuberculoma and extramedullary tuberculoma were mainly isointense on T1-weighted imaging (T1WI) and hypointense or isointense on T2WI. Rim enhancement was observed in intramedullary tuberculoma, and marked homogeneous enhancement was dominant in extramedullary tuberculoma. Ten (10/24) tuberculomas occurred during antituberculous therapy, with intradural extramedullary tuberculoma accounting for 7 cases (7/8), which was significantly more frequent than intramedullary tuberculoma (1/6) or epidural tuberculoma (2/10).ConclusionMRI is important in the diagnosis of intraspinal tuberculoma, which is characterized by isointensity on T1WI, isointensity, or hypointensity on T2WI, and rim or obvious homogeneous enhancement. Some intraspinal tuberculomas, especially intradural extramedullary tuberculomas, might be associated with the “paradoxical response” mechanism during the tuberculosis treatment.
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Affiliation(s)
- Yirui Zhou
- Department of Radiology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yong Qin
- Department of Radiology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Tong Mu
- Department of Radiology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
| | - Helin Zheng
- Department of Radiology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jinhua Cai
- Department of Radiology, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Jinhua Cai
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Kaur H, Mittal GK, Singhdev J. Intradural extramedullary tuberculoma of the spinal cord in patient of tubercular meningitis - an uncommon scenario. Indian J Tuberc 2020; 67:426-429. [PMID: 32825887 DOI: 10.1016/j.ijtb.2020.05.001] [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] [Received: 03/30/2020] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
Intradural extramedullary tuberculoma of the spinal cord (IETSC) is a rare and unanticipated manifestation of CNS tuberculosis. A 28 years old female diagnosed case of tubercular meningitis (TBM), already on antitubercular therapy (ATT) for last nine months, developed sensory and motor weakness in lower limbs along with saddle anaesthesia. Magnetic resonance imaging (MRI) with contrast of the spine revealed the presence of multiple space occupying lesions in dorsal spinal cord. She received oral steroid therapy for six weeks with escalation of ATT after which neurological functions improved remarkably.
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Affiliation(s)
- Harleen Kaur
- Department of Neurology, St Stephen's Hospital, Delhi, 110054, India
| | | | - Jennifer Singhdev
- Department of Neurology, St Stephen's Hospital, Delhi, 110054, India
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Ghane VR, Shanbag P, Meshram A. Coexisting Spinal Intramedullary and Intracranial Tuberculomas in an Immunocompetent Child. J Pediatr Neurosci 2019; 14:143-147. [PMID: 31649775 PMCID: PMC6798273 DOI: 10.4103/jpn.jpn_12_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/23/2019] [Accepted: 07/22/2019] [Indexed: 11/06/2022] Open
Abstract
Pediatric neurotuberculosis manifests commonly as tuberculous meningitis and intracranial tuberculomas. The ratio of occurrence of intracranial to intraspinal tuberculoma reported is 42:1. Intramedullary tuberculomas (IMTs) are rare, and the coexistence of intramedullary and intracranial tuberculoma is extremely rare. We report a case of coexisting intramedullary and intracranial tuberculoma in a 5-year-old boy who presented with fever for 12 days, progressive motor weakness in the lower limbs for 9 days, and retention of urine and constipation for 6 days. Neurological examination revealed signs of compressive myelopathy. Magnetic resonance imaging (MRI) of the spine detected IMT at D4-D5 level of the thoracic cord with perilesional edema. MRI of brain revealed a right frontal tuberculoma. Medical management with antituberculosis therapy and steroids resulted in complete neurological recovery.
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Affiliation(s)
- Vaishali R. Ghane
- Department of Paediatrics, ESI Post Graduate Institute of Medical Science and Research and ESIC Model Hospital, Andheri, Mumbai, Maharashtra, India
| | - Preeti Shanbag
- Department of Paediatrics, ESI Post Graduate Institute of Medical Science and Research and ESIC Model Hospital, Andheri, Mumbai, Maharashtra, India
| | - Ashish Meshram
- Department of Paediatrics, ESI Post Graduate Institute of Medical Science and Research and ESIC Model Hospital, Andheri, Mumbai, Maharashtra, India
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Chen F, Chen L, Cao Y, Yi Y, Zhuang J, Le W, Xie W, Tu L, Li P, Fang Y, Li L, Kou Y, Fu K, He H, Ju H. Intracisternal tuberculoma: a refractory type of tuberculoma indicating surgical intervention. BMC Neurol 2018; 18:10. [PMID: 29347976 PMCID: PMC5772699 DOI: 10.1186/s12883-017-0996-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 11/29/2017] [Indexed: 11/16/2022] Open
Abstract
Background Central nervous system (CNS) tuberculoma is a rare disease with severe neurological deficits. This retrospective research is to review the data of patients diagnosed as CNS tuberculoma. Surgeries were performed in all patients. The clinical features especially the neurological image and the anatomical characters of the tuberculomas were concerned. Methods Totally 11 patients diagnosed as CNS tuberculoma were admitted in Guangzhou First People’s Hospital (7cases) and Changzheng Hospital (4 cases) during 2006–2015. The data including preoperative condition, neurological imaging, and surgical findings was collected and analyzed. Results The lesions of nine patients (9/11) were totally or subtotally excised and two (2/11) were partially excised. Neurological functions of all patients were improved after surgery without secondary infection. Lesions of nine (9/11) patients preoperatively progressed as a result of paradoxical reaction. Of the 9 patients demonstrated paradoxical progression, all lesions were partially or totally located at the cisterns or the subarachnoid space. Preoperative ATTs lasted 2 to 12 months and tuberculomas were not eliminated. The arachnoid was found thickened and tightly adhered to the lesions during surgeries. Of the 2 cases that paradoxical reaction were excluded, both patients (case 6, intramedullary tuberculoma; case 11, intradural extramedullary tuberculoma) were admitted at onset of the disease. ATTs were preoperatively given for 1 week as neurological deficits aggravated. The tuberculous lesions of CNS or other system showed no obvious change and paradoxical reaction could not be established in both cases. Conclusions Exudates of tuberculosis is usually accumulated in the cisterns and frequently results in the paradoxical formation of tuberculoma. Intracisternal tuberculoma is closely related to paradoxical reaction and refractory to anti-tuberculosis therapy. Micro-surgical excision is safe and effective. Early surgical intervention may be considered in the diagnosis of intracisternal tuberculoma especially when paradoxical reaction participates in the development of tuberculoma.
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Affiliation(s)
- Fanfan Chen
- Neurosurgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, 1# Panfu Road, Guangzhou, Guangdong, 510180, China
| | - Lei Chen
- Neurosurgery Department, Shenzhen Second People's Hospital, Shenzhen University, 3002# Sungang Road, Shenzhen, 518037, China
| | - Yongfu Cao
- Neurosurgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, 1# Panfu Road, Guangzhou, Guangdong, 510180, China
| | - Yongjun Yi
- Neurosurgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, 1# Panfu Road, Guangzhou, Guangdong, 510180, China
| | - Jingwen Zhuang
- Neurosurgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, 1# Panfu Road, Guangzhou, Guangdong, 510180, China
| | - Wuhua Le
- Neurosurgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, 1# Panfu Road, Guangzhou, Guangdong, 510180, China
| | - Wei Xie
- Neurosurgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, 1# Panfu Road, Guangzhou, Guangdong, 510180, China
| | - Lanbo Tu
- Neurosurgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, 1# Panfu Road, Guangzhou, Guangdong, 510180, China
| | - Peng Li
- Neurosurgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, 1# Panfu Road, Guangzhou, Guangdong, 510180, China
| | - Yimin Fang
- Tuberculosis Department, Guangzhou Chest Hospital, 62# Hengzhi Gang Road, Guangzhou, Guangdong, 510095, China
| | - Ling Li
- Record Department, Guangzhou First People's Hospital, Guangzhou Medical University, 1# Panfu Road, Guangzhou, Guangdong, 510180, China
| | - Yuqing Kou
- Department of Navy Medicine, The Second Military Medical University, 800# Xiangyin Road, Shanghai, 200433, China
| | - Kaikai Fu
- Department of Navy Medicine, The Second Military Medical University, 800# Xiangyin Road, Shanghai, 200433, China
| | - Hua He
- Neurosurgery Department, Changzheng Hospital, The Second Military Medical University;State key Laboratory of Drug Research, Shanghai Institute of Material Medical, Chinese Academy of Sciences, 415# Fengyang Road, Shanghai, 200003, China.
| | - Hongbin Ju
- Spinal Surgery Department, Guangzhou First People's Hospital, Guangzhou Medical University, 1# Panfu Road, Guangzhou, Guangdong, 510180, China.
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Krishnan SS, Patel BR, Vasudevan MC. Concurrent Multilevel Spinal Intra-medullary with Extensive Intracranial Tuberculomas: A Rare Case Report. Asian J Neurosurg 2017; 12:774-778. [PMID: 29114310 PMCID: PMC5652122 DOI: 10.4103/1793-5482.185073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Disseminated tuberculomas in the brain and spinal cord are rare. To the best of our knowledge, only nine cases of spinal intra-medullary tuberculomas with cranial involvement have been reported till date. However, involvement of all levels in the spinal cord, brain stem with pan lobar involvement of the cerebrum and cerebellum has not been reported so far. We present such a case of a 12-year-old boy with history of pulmonary tuberculosis, who presented with gradual onset of quadriparesis and generalized seizures. We have discussed the unusual clinical presentation and the temporal changes in magnetic resonance imaging features along with clinical response to treatment. In cases reported so far, the plan of surgical versus medical management has been opted for variably, in cases of spinal intra-medullary involvement with acute neurological deficit. The decision is even more difficult in multilevel spinal intra-medullary tuberculomas. Our patient showed good clinico-radiological improvement with medical management.
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Affiliation(s)
- Shyam Sundar Krishnan
- Department of Neurosurgery, Achanta Lakshmipathi Neurosurgical Centre, Voluntary Health Services, Taramani, Chennai, Tamil Nadu, India
| | - Bhavinkumar Rameshchandra Patel
- Department of Neurosurgery, Achanta Lakshmipathi Neurosurgical Centre, Voluntary Health Services, Taramani, Chennai, Tamil Nadu, India
| | - Madabushi Chakravarthy Vasudevan
- Department of Neurosurgery, Achanta Lakshmipathi Neurosurgical Centre, Voluntary Health Services, Taramani, Chennai, Tamil Nadu, India
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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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7
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Garg RK, Malhotra HS, Gupta R. Spinal cord involvement in tuberculous meningitis. Spinal Cord 2015; 53:649-57. [PMID: 25896347 DOI: 10.1038/sc.2015.58] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 02/24/2015] [Accepted: 03/04/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To summarize the incidence and spectrum of spinal cord-related complications in patients of tuberculous meningitis. SETTING Reports from multiple countries were included. METHODS An extensive review of the literature, published in English, was carried out using Scopus, PubMed and Google Scholar databases. RESULTS Tuberculous meningitis frequently affects the spinal cord and nerve roots. Initial evidence of spinal cord involvement came from post-mortem examination. Subsequent advancement in neuroimaging like conventional lumbar myelography, computed tomographic myelography and gadolinium-enhanced magnetic resonance-myelography have contributed immensely. Spinal involvement manifests in several forms, like tuberculous radiculomyelitis, spinal tuberculoma, myelitis, syringomyelia, vertebral tuberculosis and very rarely spinal tuberculous abscess. Frequently, tuberculous spinal arachnoiditis develops paradoxically. Infrequently, spinal cord involvement may even be asymptomatic. Spinal cord and spinal nerve involvement is demonstrated by diffuse enhancement of cord parenchyma, nerve roots and meninges on contrast-enhanced magnetic resonance imaging. High cerebrospinal fluid protein content is often a risk factor for arachnoiditis. The most important differential diagnosis of tuberculous arachnoiditis is meningeal carcinomatosis. Anti-tuberculosis therapy is the main stay of treatment for tuberculous meningitis. Higher doses of corticosteroids have been found effective. Surgery should be considered only when pathological confirmation is needed or there is significant spinal cord compression. The outcome in these patients has been unpredictable. Some reports observed excellent recovery and some reported unfavorable outcomes after surgical decompression and debridement. CONCLUSIONS Tuberculous meningitis is frequently associated with disabling spinal cord and radicular complications. Available treatment options are far from satisfactory.
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Affiliation(s)
- R K Garg
- Department of Neurology, King George Medical University, Uttar Pradesh, India
| | - H S Malhotra
- Department of Neurology, King George Medical University, Uttar Pradesh, India
| | - R Gupta
- Department of Neurology, King George Medical University, Uttar Pradesh, India
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8
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Park JH, Kim YH, Kwon CH, Shin HI. Paralysis developing as a paradoxical response during the treatment for tuberculous spondylitis: a case report. Ann Rehabil Med 2014; 38:405-9. [PMID: 25024967 PMCID: PMC4092184 DOI: 10.5535/arm.2014.38.3.405] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 08/21/2013] [Indexed: 11/06/2022] Open
Abstract
It can be difficult for clinicians to distinguish a paradoxical response to antituberculous therapy, worsening of an existing lesion despite adequate treatment, treatment failure, and drug resistance. We report a case of a 69-year-old woman who experienced bilateral lower extremity paralysis secondary to a paradoxical response. She had been suffering for 1 month from low back pain, due to tuberculous spondylitis. Her low back pain improved after antituberculous therapy. The low back pain, however, reappeared 2 months after treatment, accompanied by newly developed lower extremity weakness. Imaging studies showed an increased extent of her previous lesions. Consequently, the patient underwent a vertebral corpectomy with interbody fusion of the thoracolumbar spine. Histopathological examination showed chronic inflamed granulation tissue with no microorganisms. Although the antituberculous medication was not changed, the patient's symptoms and signs, including the paralysis, resolved after surgery.
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Affiliation(s)
- Jae Hyeon Park
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yeo Hyung Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chan Hyuk Kwon
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Ik Shin
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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9
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Garg RK, Malhotra HS, Kumar N. Paradoxical reaction in HIV negative tuberculous meningitis. J Neurol Sci 2014; 340:26-36. [PMID: 24680563 DOI: 10.1016/j.jns.2014.03.025] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 02/21/2014] [Accepted: 03/12/2014] [Indexed: 01/06/2023]
Abstract
This review focusses on paradoxical reactions occurring during the treatment of tuberculous meningitis (TBM) in human immunodeficiency virus-negative cases. A paradoxical reaction is defined as the worsening of a pre-existing lesion or the appearance of new lesion in a patient whose clinical symptoms initially improved with anti-tuberculosis treatment. A number of different paradoxical reactions have been reported in patients with TBM including expansion of existing cerebral tuberculomas, and appearance of new tuberculomas, hydrocephalus, and optochiasmatic and spinal arachnoiditis. While the exact mechanism of paradoxical reactions is uncertain, an exaggerated immune reaction against Mycobacterium tuberculosis-associated antigens is currently the most accepted theory for tuberculous paradoxical reaction. Corticosteroids are considered to have a beneficial effect in the management of paradoxical reactions. Immuno-modulatory drugs, including tumor necrosis factor-α antagonists, thalidomide and interferon-γ have been used in isolated cases with more severe forms of paradoxical reactions.
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Affiliation(s)
- Ravindra Kumar Garg
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India.
| | | | - Neeraj Kumar
- Department of Neurology, King George Medical University, Lucknow, Uttar Pradesh, India
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10
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Agarwal N, Shah J, Hansberry DR, Mammis A, Sharer LR, Goldstein IM. Presentation of cauda equina syndrome due to an intradural extramedullary abscess: a case report. Spine J 2014; 14:e1-6. [PMID: 24331844 DOI: 10.1016/j.spinee.2013.09.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 08/12/2013] [Accepted: 09/19/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Cauda equina syndrome is caused by compression or injury to the nerve roots distal to the level of the spinal cord. This syndrome presents as low back pain, motor and sensory deficits in the lower extremities, and bladder as well as bowel dysfunction. Although various etiologies of cauda equina syndrome have been reported, a less common cause is infection. PURPOSE To report a case of cauda equina syndrome caused by infection of an intradural extramedullary abscess with Staphylococcus aureus. STUDY DESIGN/SETTING Case report and review of the literature. METHODS The literature regarding the infectious causes of cauda equina syndrome was reviewed and a case of cauda equina syndrome caused by infection of an intradural extramedullary abscess with Staphylococcus aureus was reported. RESULTS A 37-year-old woman, with history of intravenous drug abuse, hepatitis C, and hepatitis B, presented with low back pain lasting 2 months, lower extremity pain, left greater than right with increasing weakness and difficulty ambulating, and urinary and fecal incontinence. Her presentation was consistent with cauda equina syndrome. The patient underwent a T12-L2 laminectomy, and intradural exploration revealed an abscess. Methicillin-resistant Staphylococcus aureus was found on wound culture. CONCLUSIONS Cauda equina syndrome, presenting as a result of spinal infection, such as the case reported here, is extremely rare but clinically important. Surgical intervention is generally the recommended therapeutic modality.
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Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, 90 Bergen St, Suite 8100, PO Box 1709, Newark, NJ 07101-1709, USA
| | - Janki Shah
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, 90 Bergen St, Suite 8100, PO Box 1709, Newark, NJ 07101-1709, USA
| | - David R Hansberry
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, 90 Bergen St, Suite 8100, PO Box 1709, Newark, NJ 07101-1709, USA
| | - Antonios Mammis
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, 90 Bergen St, Suite 8100, PO Box 1709, Newark, NJ 07101-1709, USA
| | - Leroy R Sharer
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, 90 Bergen St, Suite 8100, PO Box 1709, Newark, NJ 07101-1709, USA
| | - Ira M Goldstein
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, 90 Bergen St, Suite 8100, PO Box 1709, Newark, NJ 07101-1709, USA.
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Sandler AL, Thompson D, Goodrich JT, van Aalst J, Kolatch E, El Khashab M, Nejat F, Cornips E, Mohindra S, Gupta R, Yassari R, Daniels LB, Biswas A, Abbott R. Infections of the spinal subdural space in children: a series of 11 contemporary cases and review of all published reports. A multinational collaborative effort. Childs Nerv Syst 2013; 29:105-17. [PMID: 23053357 DOI: 10.1007/s00381-012-1916-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 08/27/2012] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Positioned anatomically between the spinal epidural space and the intramedullary compartment, the spinal subdural space remains the least common area of localized infection in the central nervous system. Infectious processes of the subdural spinal space include subdural spinal empyema, subdural spinal abscess, infected spinal subdural cyst, and infectious spinal subdural cyst. To date, there has been no systematic review of these entities in children, with the cumulative knowledge of the pathophysiologic, microbiologic, and demographic characteristics of these infections relegated solely to few small series and case reports. METHODS A series of 11 recent cases culled from the collaboration of international authors are presented. In addition, an exhaustive MEDLINE search and manual review of the international literature was performed, identifying a total of 73 cases of spinal subdural infections in patients under the age of 21. Data of interest include the age, sex, signs, and symptoms at presentation, spinal location of infection, presence of spinal dysraphism, and other comorbidities, offending organism, treatment, outcome, and follow-up. RESULTS Patients ages ranged from 4 weeks to 20 years (mean, 6.5 years). Males outnumbered females by a ratio of 2:1. Over half (53 %) of spinal subdural infections in children were associated with spinal dysraphism or other congenital abnormalities of the spine. The commonest organism to infect the spinal subdural space in children is mycobacterium tuberculosis and the thoracic spinal region was most commonly infected. CONCLUSIONS The disease is usually treated surgically, although a more expectant approach consisting of antibiotics and observation has also been proposed.
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Affiliation(s)
- Adam L Sandler
- Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 3316 Rochambeau Avenue, Bronx, NY 10467, USA.
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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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Choi YS, Park KH, Choi DH. Co-occurrence of cervical and thoracic intradural extramedullary tuberculoma following tuberculosis meningitis. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.ejrex.2011.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Calaf F, Oleaga L, Sigritz N, Squarcia M, González S, Berenguer J. Magnetic resonance imaging findings of a case of an intradural-extramedullary tuberculoma of the spinal cord. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.ejrex.2008.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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16
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Central nervous system tuberculosis: pathogenesis and clinical aspects. Clin Microbiol Rev 2008; 21:243-61, table of contents. [PMID: 18400795 DOI: 10.1128/cmr.00042-07] [Citation(s) in RCA: 363] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Tuberculosis of the central nervous system (CNS) is a highly devastating form of tuberculosis, which, even in the setting of appropriate antitubercular therapy, leads to unacceptable levels of morbidity and mortality. Despite the development of promising molecular diagnostic techniques, diagnosis of CNS tuberculosis relies largely on microbiological methods that are insensitive, and as such, CNS tuberculosis remains a formidable diagnostic challenge. Insights into the basic neuropathogenesis of Mycobacterium tuberculosis and the development of an appropriate animal model are desperately needed. The optimal regimen and length of treatment are largely unknown, and with the rising incidence of multidrug-resistant strains of M. tuberculosis, the development of well-tolerated and effective antibiotics remains a continued need. While the most widely used vaccine in the world largely targets this manifestation of tuberculosis, the BCG vaccine has not fulfilled the promise of eliminating CNS tuberculosis. We put forth this review to highlight the current understanding of the neuropathogenesis of M. tuberculosis, to discuss certain epidemiological, clinical, diagnostic, and therapeutic aspects of CNS tuberculosis, and also to underscore the many unmet needs in this important field.
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Takahashi H, Ito S, Kojima S, Tanno T, Hattori T. Intradural extramedullary tuberculoma of the thoracic spine: paradoxical response to antituberculous therapy. Intern Med 2008; 47:797-8. [PMID: 18421202 DOI: 10.2169/internalmedicine.47.0839] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Intradural extramedullary tuberculoma of the spinal cord (IETSC) is a rare complication of tuberculosis, which can occur as a paradoxical response to antituberculous therapy. A 46-year-old woman with tuberculosis meningitis developed an acute sensory disturbance and paraplegia eight weeks after the antituberculous treatment was started. MRI revealed a cystic lesion at the Th 2 and 3 vertebrae levels, and continuous dural thickening. Laminectomy was performed; soft granulomas were unexpectedly observed inside the dura matter. After the operation, the patient experienced progressive improvement in motor strength. IETSC should be known as rare but possible complication of tuberculous meningitis.
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Affiliation(s)
- Hirokatsu Takahashi
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba.
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