Transient Elevation of Cerebrospinal Fluid Protein in a Patient of Mild Encephalitis with Reversible Lesion in the Splenium: A Case Report

Mild encephalitis with reversible lesion in the splenium (MERS) is a clinicoradiological syndrome presenting as a solitary lesion in the central portion of the splenium of the corpus callosum (SCC) with a radiological finding of restricted diffusion and low apparent diffusion coefficient (ADC) values. Complete resolution of the lesion on follow-up imaging and full clinical recovery are the hallmarks of this syndrome, even with only supportive therapy. MERS is usually associated with normal Cerebrospinal fluid (CSF) findings and an excellent prognosis, even without corticosteroid therapy. Magnetic resonance imaging (MRI) is the ideal modality for initial diagnosis and follow-up. Not many cases of this uncommon clinicoradiological syndrome with transient elevation of CSF proteins have been reported. In the subsequent sections, we present a case report of this unusual clinicoradiological entity with raised CSF protein. We also elaborate on possible differential diagnoses and the syndrome’s proposed pathophysiology.

Intramedullary craniovertebral junction tuberculoma: an uncommon location of a common disease

Central nervous system involvement is observed in no more than 10% of patients with systemic tuberculosis. Although CNS tuberculosis is not rare in endemic countries, such as India, intramedullary tuberculosis is not commonly reported. In this study, we report a case of a 40-year-old female who presented with a six-year history of insidious onset, gradually progressive, asymmetric quadriparesis. She was diagnosed with intramedullary tuberculoma at the craniovertebral junction and showed significant clinico-radiological improvement with medical management alone. To the best of our knowledge, this report describes the first case of intramedullary tuberculoma at the craniovertebral junction to be reported. With the increased availability of MRI in developing countries, it is now possible for clinicians to diagnose this condition without performing a biopsy. It is important for the clinicians in developed countries to be highly suspicious of intramedullary tuberculoma, as there has been a resurgence of CNS tuberculosis due to the emergence of the HIV pandemic