Spinal Epidural Tuberculoma: A Novel Case Report
Mortality and morbidity rates due to the involvement of the central nervous system (CNS) tuberculosis are higher than those due to the involvement of other organ systems. Spinal tuberculosis is very rare and constitutes only 2% of CNS tuberculosis cases. A 17-year-old male patient presented with complaints of progressive loss of strength in both legs that started with numbing of the legs for three months. One-fifth loss of strength in both legs and an increase in patellar reflex were found in the motor examination. On performing unenhanced lumbar magnetic resonance imaging, the mass lesion extending from L1–L4 that was thought to be a subacute epidural hematoma was tracked. The patient was taken into operation immediately after the pre-diagnosis of subacute epidural hematoma was made. The lesion reached from the L1 vertebral corpus to the L4 corpus and had a size of 6×1 cm. Progressive improvement was seen in the paresis of the patient postoperatively. In the histopathological examination, histiocytes, lymphocytes showing caseous necrosis, and necrotizing granuloma inflammatory reaction showing granuloma structures formed by single neutrophils were observed. In line with the examination report, the patient was given a three-step anti-tuberculosis therapeutic protocol (ethambutol, rifampicin, and isoniazid) for nine months.
1.Yaman M. Pathogenesis of Tuberculosis. Istanbul University, Cerrahpaşa School of Medicine Continuing Education Center, Symposium on Tuberculosis in Adults and Children. 1999;15– 20.
2. Li H, Liu W, You C. Central nervous system tuberculoma. J Clin Neurosci 2012;19:691–5. [CrossRef]
3. Hamada J, Sato K, Seto H, Ushio Y. Epidural tuberculoma of the spine: case report. Neurosurgery 1991;28:161–3. [CrossRef]
4. Golden MP, Vikram HR. Extrapulmonary tuberculosis: an overview. Am Fam Physician 2005;72:1761–8.
5. Balaparameswararao S, Dinkar I. Intramedullary tuberuloma of the spinal cord. A case with a five year follow-up. Indian J Med Sci 1970;24:647–9.
6. Griffith DL, Seddon HJ, Roaf R. Pott’s Paraplegia. London; Oxford University Press: 1956; p. 4–21.
7. Gupta VK, Sharma BS, Khosla VK. Intramedullary tuberculoma: report of two cases with MRI findings. Surg Neurol 1995;44:241–3. [CrossRef]
8. Ohaegbulam SC. Spinal extraosseous extradural tuberculo-ma. Tubercle 1977;58:97–9. [CrossRef]
9. Kak VK, Pani KC, Chopra JS. Epidural spinal tuberculoma presenting as 'spinal tumour syndrome'. Tubercle 1972;53:139– 42. [CrossRef]
10. Burgielski R, Lechowski S. Epidural tuberculoma of the spinal canal. Gruzlica 1975;43:507–8.
11. Plese JP, Elkis LC, Nogueira RG, de Barros JE, França IC. Radicular syndrome caused by epidural tuberculous granuloma. Case report. Arq Neuropsiquiatr 1978;36:160–3. [CrossRef]
12. Reichenthal E, Cohen ML, Shalit MN. Extraosseous extradural tuberculous granuloma of the cervical spine: a case report and review of intraspinal granulomatous infections. Surg Neurol 1981;15:178–81. [CrossRef]
13. Chin D, Burrow D, Edis R, Lekias J. Extraosseous extradural tuberculous granuloma of the spine. Surg Neurol 1983;19:428– 30. [CrossRef]
14. Mantzoros CS, Brown PD, Dembry L. Extraosseous epidural tuberculoma: case report and review. Clin Infect Dis 1993;17:1032–6. [CrossRef]
15. Bhatoe HS. Epidural spinal tuberculoma. Australas Radiol 1995;39:179–81. [CrossRef]