Concurrent Multilevel Spinal Intra-medullary with Extensive Intracranial Tuberculomas: A Rare Case Report

Intracranial and Spinal Tuberculosis: A Rare Entity

CNS tuberculosis has a broad spectrum of disease patterns and a high risk of complications and mortality. We present a case of a 36-year-old man who was diagnosed with neurotuberculosis with intracranial and spinal tuberculomas, meningitis, and spondylodiscitis. The patient was a known case of sarcoidosis and was being managed on corticosteroids. His presenting complaints were headache, low-grade fever, severe backache, lower limb weakness, and one episode of altered sensorium. The initial diagnosis was based on imaging findings, which were confirmed with positive cerebrospinal fluid (CSF) culture for Mycobacterium tuberculosis. Imaging and clinicopathological correlation enables early diagnosis and treatment and prevents permanent neurological sequelae.

Pott's Disease with Incidentally Discovered Multiple Brain Tuberculomas in a Previously Healthy 10-Year-Old Girl

Pott's disease (PD) represents the most common form of spinal tuberculosis. Its association with brain tuberculomas is extremely rare. Herein, we report a previously healthy child with PD and concurrent multiple brain tuberculomas who was successfully treated with antituberculous therapy, surgical drainage of the paravertebral abscess, and adjuvant steroid therapy.

The ring in the neck-managing paraparesis in cervical intramedullary tuberculoma: Inputs from a neurorehabilitation desk

Central nervous system (CNS) tuberculosis is a less common entity even in endemic countries like India. Involvement of spine is much less frequent than brain, but concurrent involvement of brain and spine by tuberculoma is rare. A 23-year-old female with paraparesis was diagnosed as having cervical ring enhancing lesion in MRI suggesting intramedullary tuberculoma along with long segment cervicodorsal edema. On brain screening she had multiple intracerebral tuberculomas without any evidence of tuberculosis elsewhere in the body. She was treated with a multidisciplinary approach including neurological management and neurorehabilitation, with remarkable clinical recovery. In presence of acute neurological deficit, early start of rehabilitation along with medical management can give outstanding results in terms of neuro-recovery and improvement of residual neurodeficits. Surgical intervention can be avoided in many cases.

A rare case of disseminated tuberculosis; multiple intracranial and intramedullary tuberculomas with concurrent tuberculous spondylitis and meningitis

Concomitant presentation of intracranial and intramedullary tuberculomas is a rare entity. We report a 38-year-old immunocompetent woman with intramedullary and intracranial tuberculomas with concurrent tuberculous spondylitis and meningitis, who presented with paraparesis and back pain. Despite initial antituberculous therapy, the patient’s neurologic status deteriorated with the development of paraplegia. Following surgical intervention, the patient gradually recovered muscle strength and bladder function.

Coexisting Spinal Intramedullary and Intracranial Tuberculomas in an Immunocompetent Child

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.

Extensive perivascular dissemination of cerebral miliary tuberculomas: a case report and review of the literature

Cerebral tuberculosis (TB) presents most frequently as meningitis in the basilar cistern; however, it can also manifest in various other ways, such as localized encephalitis, abscess, and tuberculoma. Here, focusing on imaging findings, we report an immunocompetent case who demonstrated multiple parenchymal lesions and was diagnosed with cerebral TB after testing positive on QuantiFERON (QTF); her clinical signs/symptoms and laboratory findings responded well to anti-TB medication therapy. The patient was a 60-year-old woman with the chief complaints of headache and consciousness disturbance. On admission, cerebrospinal fluid (CSF) examination showed increased monocyte predominance. T2-weighted images showed multiple, widely distributed hyperintense lesions in the periventricular and deep white matter. Gadolinium-enhanced three-dimensional gradient echo T1-weighed images revealed numerous granules or faint, small, enhanced foci in lesions in the periventricular and deep white matter, central gray matter, and hippocampus. Some abnormal sulcal enhancement was detected in the pia mater, indicating meningitis. Clinically, the diagnosis was difficult to make, but as the QTF result was positive, anti-TB drugs were administered, after which both the symptoms and CSF cell count showed improvement.