ABSTRACT
Intradural extramedullary (IDEM) tuberculoma of the spinal cord is uncommon entity and moreover, few reports have been documented on concurrent IDEM and intracranial tuberculomas. Authors report a case of IDEM spinal tuberculoma having intracranial lesion simultaneously. A 49-year-old woman suffered from paraparesis and urinary incontinence while being given medical treatment for tuberculous meningitis. Magnetic resonance imaging (MRI) revealed an IDEM mass lesion between the T1 and T2 spinal levels, and multiple intracranial tuberculous granulomas. Surgical resection of the IDEM tuberculoma followed by anti-tuberculous medication resulted in good outcome.
Subject(s)
Female , Humans , Brain/diagnostic imaging , Follow-Up Studies , Magnetic Resonance Imaging , Middle Aged , Mycobacterium tuberculosis/isolation & purification , Spinal Cord Diseases/diagnostic imaging , Tuberculoma/surgery , Tuberculoma/diagnostic imaging , Tuberculoma/drug therapy , Tuberculoma/complications , Tuberculosis, Meningeal/surgery , Tuberculosis, Meningeal/diagnostic imaging , Tuberculosis, Meningeal/drug therapy , Tuberculosis, Meningeal/complicationsABSTRACT
OBJECTIVE: To study the diagnostic test characteristics of computed tomography (CT scan) in differentiating tuberculous (TBM) and pyogenic (PM) meningitis. DESIGN: Prospective diagnostic test evaluation. SETTING: Teaching hospital. METHODS: Children beyond 1 month of age admitted with meningitis were enrolled prospectively and CT scan done. Results of CT scan were compared with predefined gold standards for the diagnosis of either TBM or PM. RESULTS: CT scan was performed in 154 patients with meningitis. Of these 94 were TBM, 52 had PM and 8 were indeterminate and excluded from analysis. Basal enhancement, ventriculomegaly, tuberculoma and infarction were all significantly more common in the TBM group, while subdural collections were seen more in the PM group. The highest sensitivity (89.2%) and specificity (100%) for diagnosis of TBM were found for basal enhancement or tuberculoma or both. CONCLUSIONS: CT scan can be used to effectively distinguish TBM and PM.