Tuberculoma intradural extramedular: descripción de un caso clínico y revisión de la bibliografía / Extramedullary intradural tuberculosis: a case report and review of the literature

Introducción. La tuberculosis del sistema nervioso central es una infección crónica común en países en vías de desarrollo, y la meningitis tuberculosa y los tuberculomas intracraneales son las formas más frecuentes. El tuberculoma intradural extramedular es una entidad poco frecuente, con pocos casos descritos en la bibliografía mundial, y por lo general se asocia a un antecedente de meningitis tuberculosa o durante el tratamiento antituberculoso. Caso clínico. Varón de 17 años, sin antecedente de tuberculosis, con cuadro clínico de una mielopatía compresiva de aparición subaguda y curso progresivo, cuya neuroimagen evidenció una lesión extensa intradural extramedular. Se le realizó cura quirúrgica más laminectomía descompresiva en D4-D8 seguido de quimioterapia. El estudio histopatológico confirmó el diagnóstico. Conclusiones. La tuberculosis del sistema nervioso central es una entidad de alta incidencia en nuestro medio, y el tuberculoma intradural extramedular debería incluirse en el diagnóstico diferencial de lesiones expansivas de la médula espinal, más aún si el paciente es joven y existe el antecedente de tuberculosis pulmonar o meningitis tuberculosa. Asimismo, es importante tenerla en cuenta como parte de una reacción paradójica después del inicio del tratamiento específico. Aunque la resección quirúrgica mejora los síntomas compresivos medulares, la terapia médica continúa siendo el pilar en el tratamiento de los tuberculomas (AU)

Introduction. Central nervous system tuberculosis is a common chronic infection in developing countries, being the most frequent forms: tuberculous meningitis and intracranial tuberculosis. Extramedullary intradural tuberculosis is a rare entity with few cases described in the world literature, and is usually associated with a history of tuberculous meningitis or during antituberculosis treatment. Case report. A 17 years-old male patient, without history of tuberculosis, with subacute onset and progressive course of compressive myelopathy. Spinal magnetic resonance imaging revealed an intradural extramedullary mass lesion between the C4 and T8 spinal levels. Surgical resection of tuberculoma was realized, followed by chemotherapy. The histopathological study confirmed the diagnostic. Conclusions. Tuberculosis of the central nervous system is an entity of high incidence in developing countries, and intradural extramedullary tuberculoma should be included in the differential diagnosis of expansive spinal cord injuries, especially if the patient is young and there is a history of pulmonary tuberculosis or tuberculous meningitis. It is also important to take it into account as part of a paradoxical reaction after the initiation of specific treatment. Although surgical resection improves compressive medullary symptoms, medical therapy remains the mainstay in the treatment of tuberculomas (AU)

Bilateral Hypertrophic Olivary Degeneration and Holmes Tremor without Palatal Tremor: An Unusual Association.

BACKGROUND: Lesions in the Guillain-Mollaret triangle or dentate-rubro-olivary pathway may lead to hypertrophic olivary degeneration (HOD), a secondary trans-synaptic degeneration of the inferior olivary nucleus. HOD is usually associated with palatal tremor and rarely with Holmes tremor. Bilateral HOD is a very unusual condition and very few cases are reported. CASE REPORT: We report here two cases of bilateral HOD after two different vascular lesions located at the decussation of superior cerebellar peduncles, thus impairing both central tegmental tracts and interrupting bilaterally the dentate-rubral-olivary pathway. Interestingly, both developed bilateral Holmes tremor but not palatal tremor. DISCUSSION: Lesions in some of the components in the Guillain-Mollaret triangle may develop Holmes tremor with HOD and without palatal tremor. Magnetic resonance imaging is an invaluable tool in these cases. Better understanding of the pathways in this loop is needed.