Non‐osseous intradural tuberculoma of the thoracic spine with compressive myelopathy
Key Clinical Message An uncommon form of CNS tuberculosis called non‐osseous IDEM tuberculoma frequently results from paradoxical drug interactions. It should be considered one of the differentials when patients receiving ATT experience acute neurological impairment. Abstract Tuberculoma affecting t...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-11-01
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| Series: | Clinical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ccr3.8131 |
| _version_ | 1797449794791145472 |
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| author | Shyam Duvuru Vivek Sanker Syed Naureen Gupta Prakash Rajurkar Sanjana Tirth Dave |
| author_facet | Shyam Duvuru Vivek Sanker Syed Naureen Gupta Prakash Rajurkar Sanjana Tirth Dave |
| author_sort | Shyam Duvuru |
| collection | DOAJ |
| description | Key Clinical Message An uncommon form of CNS tuberculosis called non‐osseous IDEM tuberculoma frequently results from paradoxical drug interactions. It should be considered one of the differentials when patients receiving ATT experience acute neurological impairment. Abstract Tuberculoma affecting the spinal cord is a rare condition in modern times. The occurrence of non‐osseous intradural tuberculosis, specifically in the spine, is even more exceptional. In fact, it is uncommon to encounter an intradural extramedullary tuberculous granuloma that lacks radiological indications of vertebral involvement, especially within the thoracic region. We present a case of a patient with a neurological deficit caused by a non‐osseous intradural tuberculoma in the thoracic region, without any associated bone involvement. The patient experienced a gradual deterioration of neurological function. An MRI of the thoracic spine revealed the presence of a tuberculoma located intradurally, extramedullary, and juxtamedullary of the T5 vertebra. The compression of the spinal cord resulted in paraparesis which was worsening to paraplegia. A D4–D6 laminectomy and microsurgical excision were performed under intraoperative neurophysiological monitoring (IONM), and the patient showed clinical recovery. Excellent clinical outcomes were achieved. However, it is crucial to consider the possibility of a non‐osseous intradural tuberculoma as a rare condition when encountering a SOL, particularly in patients with a history of tuberculosis and spinal cord compression. In cases where a progressing neurological deficit is present, a combination of surgical intervention and anti‐tuberculous treatment should be considered as the optimal approach. |
| first_indexed | 2024-03-09T14:30:11Z |
| format | Article |
| id | doaj.art-dafc93c2b38c4c3fbd82a6af6c28248d |
| institution | Directory Open Access Journal |
| issn | 2050-0904 |
| language | English |
| last_indexed | 2024-03-09T14:30:11Z |
| publishDate | 2023-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Clinical Case Reports |
| spelling | doaj.art-dafc93c2b38c4c3fbd82a6af6c28248d2023-11-28T04:14:44ZengWileyClinical Case Reports2050-09042023-11-011111n/an/a10.1002/ccr3.8131Non‐osseous intradural tuberculoma of the thoracic spine with compressive myelopathyShyam Duvuru0Vivek Sanker1Syed Naureen2Gupta Prakash3Rajurkar Sanjana4Tirth Dave5Department of Neurosurgery Apollo Specialty Hospitals Madurai Tamil Nadu IndiaTeam Erevnites Trivandrum IndiaTeam Erevnites Trivandrum IndiaTeam Erevnites Trivandrum IndiaTeam Erevnites Trivandrum IndiaTeam Erevnites Trivandrum IndiaKey Clinical Message An uncommon form of CNS tuberculosis called non‐osseous IDEM tuberculoma frequently results from paradoxical drug interactions. It should be considered one of the differentials when patients receiving ATT experience acute neurological impairment. Abstract Tuberculoma affecting the spinal cord is a rare condition in modern times. The occurrence of non‐osseous intradural tuberculosis, specifically in the spine, is even more exceptional. In fact, it is uncommon to encounter an intradural extramedullary tuberculous granuloma that lacks radiological indications of vertebral involvement, especially within the thoracic region. We present a case of a patient with a neurological deficit caused by a non‐osseous intradural tuberculoma in the thoracic region, without any associated bone involvement. The patient experienced a gradual deterioration of neurological function. An MRI of the thoracic spine revealed the presence of a tuberculoma located intradurally, extramedullary, and juxtamedullary of the T5 vertebra. The compression of the spinal cord resulted in paraparesis which was worsening to paraplegia. A D4–D6 laminectomy and microsurgical excision were performed under intraoperative neurophysiological monitoring (IONM), and the patient showed clinical recovery. Excellent clinical outcomes were achieved. However, it is crucial to consider the possibility of a non‐osseous intradural tuberculoma as a rare condition when encountering a SOL, particularly in patients with a history of tuberculosis and spinal cord compression. In cases where a progressing neurological deficit is present, a combination of surgical intervention and anti‐tuberculous treatment should be considered as the optimal approach.https://doi.org/10.1002/ccr3.8131myelopathyspinal cordthoracic spinetuberculoma |
| spellingShingle | Shyam Duvuru Vivek Sanker Syed Naureen Gupta Prakash Rajurkar Sanjana Tirth Dave Non‐osseous intradural tuberculoma of the thoracic spine with compressive myelopathy Clinical Case Reports myelopathy spinal cord thoracic spine tuberculoma |
| title | Non‐osseous intradural tuberculoma of the thoracic spine with compressive myelopathy |
| title_full | Non‐osseous intradural tuberculoma of the thoracic spine with compressive myelopathy |
| title_fullStr | Non‐osseous intradural tuberculoma of the thoracic spine with compressive myelopathy |
| title_full_unstemmed | Non‐osseous intradural tuberculoma of the thoracic spine with compressive myelopathy |
| title_short | Non‐osseous intradural tuberculoma of the thoracic spine with compressive myelopathy |
| title_sort | non osseous intradural tuberculoma of the thoracic spine with compressive myelopathy |
| topic | myelopathy spinal cord thoracic spine tuberculoma |
| url | https://doi.org/10.1002/ccr3.8131 |
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