Spinal cord tuberculosis

Clinical history
This 21-year-old female patient first presented with headache and fever without neck rigidity. Progressively, she became confused and agitated. Imaging investigation (CT and MRI) of the brain revealed multiple small (6-7 mm) ring-enhancing cerebral lesions. X-ray and subsequently high resolution CT of the chest showed scattered nodular lesions within the lungs. The diagnosis of miliary tuberculosis of the lungs complicated with brain abscesses was made and anti-TB treatment started. The patient's symptoms initially improved but six weeks later, she started complaining of mid-thoracic pain and progressively she developed gait disturbances.

MRI findings
Image 1: Sagittal T1WI. A slightly hyperintense round lesion (arrow) surrounded by a hypointense intramedullary area is shown.
Image 2: Sagittal T2WI. This nodular lesion has a hypointense rim with a central hyperintensity reflecting caseous necrosis.
Hyperintense ill-delineated areas are seen above and below the lesion, indicating diffuse and extensive edema of the cord.
Image 3: Sagittal Gd T1WI: A strong rim enhancement is seen at the periphery of this nodular lesion.
Image 4: Axial Gd T1WI demonstrates the intramedullary location of this tuberculoma.

Search also:
- Tuberculoma

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