Reviewof Published Literature Regardingspinal Cord Involvement in Patients with Tuberculous

1

Reviewof published literature regardingspinal cord involvement in patients with tuberculous meningitis

SS / Author, year / Type of study / Age/Sex
(age in years) / Initial diagnosis / Manifestation/s / Type of spinal cord involvement / Treatment / Outcome
S. No. / Duration since TBM and spinal manifestation / Biochemical / Neuroimaging
1 / Ransome and Montiero 1947 / Case reports (4 patients) / Adults (age and sex not mentioned) / Fever of unknown origin, later diagnosed as TBM / Paraparesis, urinary incontinence / Froin's syndrome (CSF protein 900 mg/dl) / Not done / Extensive arachnoiditis on autopsy / Not mentioned / All died
2 / Brooks et al 1954 / Case series of 80 patients of TBM / 75 patients >10 years old / TBM / After variable duration, Paraparesis and bowel/bladder involvement / Not known / Not done / 10 patients had transverse myelitis; 15 had spinal block / Patients of spinal block received intrathecal streptomycin / 38 patients died;
3 / Jenkins 1963 / Case report / 61M / TBM / Bladder/bowel symptoms / Polymorphonuclear pleocytosis / Air Myelography
Biopsy / Chronic adhesive arachnoiditis / ATT / Improved
4 / Gomez & Ziegler, 1966 / Case report / 26F / TBM / Flaccid paraparesis (T10-11) developed after 5 months / Myelography / Radiculomyelitis / ATT / Recovered
5 / Kocen and Parsons 1970 / Case series of 18 patients (1 had spinal manifestation after TBM) / 24F / TBM / Paraplegia developed 6 weeks after TBM (later on incontinence of urine) / CSF cell 277/µl and CSF protein 350 mg/dl (later 5000 mg/dl) / Not done (CSF manometry showed spinal block) / Intradural lesion / ATT and corticosteroids / Improved
6 / Giménez-Roldán et al 1974 / Case reports / 33M
28M
46F
26F / TBM in early infancy
TBM at the age 18
TBM at the age 26
TBM at the age 10 / After 13 years, paraparesis
atrophy of the hands and paraparesis
Progressive atrophy of left hand followed by paresis of her left leg. Two years later the right leg was affected.
Severe spastic quadriparesis evolving over a period of 8 years. Sensation for pin-prick and temperature was absent in the C 2 to T 6 dermatomes. / Air ventriculography demonstrated marked hydrocephalus; Syringomyelia in cervical an thoracic region, extensive thick arachnoid adhesions
Myelography showed Fragmentation and multilevel blockage; Syringomyelia in cervical and thoracic region
Myelography showed Block at the T8 level with spinal arachnoiditis. The spinal canal was slightly enlarged in the
cervical and thoracic regions.
.
Myelography showed a complete block at the T 6 level, highly suggestive of spinal arachnoiditis: blindness / Syrinx, arachnoiditis
Spinal block and syrinx
Arachnoiditis and spinal block
arachnoiditis / ventriculo-atrial shunting procedure
A ventriculo-atrial shunt
Debridement of thoracic cord / Died after surgery
Remained unchanged
Remained unchanged
Further deteriorated
7 / Savoiardo 1976 / Case report / 39M / TBM 15 year back / Quadriparesis (spastic paraplegia in lower limbs since 15 year and gradually progressive flaccid weakness in upper limbs later on) / Normal CSF at time of upper limb weakness / Air myelogram / Arachnoiditis,
Syringomyelia / Intrathecal ATT at time of TBM diagnosis(15 year back) / Not improved
8 / Freilich and Swash 1979 / Case reports / 34F
58M
29F
24M
48M
61M / TBM
TBM
TBM
Pulmonary tuberculosis and TBM
TBM
TBM by CSF / 3months,
areflexic paraparesis
Initial manifestation,
a flaccid areflexic
paraparesis, both plantar were extensor
Initial manifestation,
areflexic paraparesis
2 years while on ATT,
flaccid areflexic
paraparesis, both plantar were extensor
Initial manifestation,
flaccid paraparesis
Initial manifestation,
flaccid paraparesis / The CSF protein was
25 g/l. / Plain radiographs and a myelogram were normal
Not done
collapse of the body of the fifth lumbar vertebra
Myelogram showed complete obstruction at 11th thoracic vertebra because of subarachnoid granuloma
Normal myelogram
myelogram
showed a filling defect at the L5/SI disc, and thickening of all the
lower lumbar and sacral nerve roots / Arachnoiditis
Arachnoiditis / ATT and corticosteroids
ATT and corticosteroids
ATT
ATT and surgery
ATT
ATT and corticosteroids and decompression / Improved
Improved
Improved
Improved
Improved
Improved
9 / De Bruyne et al 1983 / Case series / 46M
64F
45F / Acute meningoencephalitis with radiculomyelitis
Chronic meningoencephalitis
Residual meningoencephalitis with spinal meningitis / Not known
Not known
Not known / Not known
Not known
Not known / Biopsy
(cauda equine exudates)
Biopsy
(cauda equine exudates)
Biopsy / Arachnoiditis
Arachnoiditis
Spinal meningeal enhancement / Not known
ATT
ATT / Died
Died
Died
10 / Vlcek et al 1984 / Case report / 73F / TBM with paraparesis / Paraplegia / CSF cells 487µl, CSF protein 4120mg/dl / Myelography, Intradural collection with arterial and venous thrombosis and cord infarction / Infection, intradural collection / ATT and antifungal with decompressive laminectomy / Died after surgery
11 / Chang et al 1989 / Case series of 13 patients / 10 patients <30 years / 11 patients had TBM at or before / paraparesis / Not mentioned / CT myelography in 13 showed Complete block (11/13) most commonly at level of conus medullaris and arachnoiditis, intradural tuberculoma (4/8);
MRI spine with contrast 2/5 tuberculoma, 3/5 arachnoiditis, 1/5 myelitis/vasculitis / Chronic adhesive arachnoiditis, tuberculoma, myelitis/vasculitis / Not reported / Not reported
12 / Caplan et al 1990 / Case series / 17M
36F
40F
26F
58M / TBM
Not known
TBM
Pyogenic meningitis
Not known / Gradual quadriparesis
Gradual quadriparesis
Paraparesis
Gradual quadriparesis (upper limb> lower limb)
Gradual quadriparesis (upper limb> lower limb) / CSF protein 260 mg%
Not known
CSF protein 90 mg/dl, CSF cells 3024 mm3
CSF cells 4/ mm3
CSF cells 5 WBC/mm3,
protein 22 mg/dL, glucose 77 mg/dL. / Biopsy; Chronic adhesive arachnoiditis and syringomyelia and cervico-thoracic cord atrophy
Myelography; Adhesive arachnoiditis and syringomyelia
Myelography and MRI spine; Conus medullaris arachnoiditis and syringomyelia (T8 to T11)
CT myelography; Syringobulbia and syringomyelia in cervical cod
Myelography / Arachnoiditis, syrinx, cord atrophy
Arachnoiditis, syrinx
Arachnoiditis, syrinx
syrinx
Syringomyelia / Not known
Catheter drainage from syrinx
ATT, steroid, catheter drainage of syrinx
Not known
Not known / Died
Not improved
Improved
Not known
Not known
13 / Van Paesschen et al 1990 / Case report / 34F / TBM 20 year back / Spastic
Paraparesis / Normal CSF at time of paraparesis / Myelography and MRI; arachnoiditis ossificans and
arachnoid cyst with small intramedullary cavitation / Arachnoiditis, syrinx / ATT and steroid at time of TBM diagnosis(20 year back) and laminectomy with decompression / Not improved
14 / Schon and Bowler 1990 / Case report / 40 / TBM (2 year back) / Flaccid weakness in upper limbs and dissociative sensory loss / CSF protein 460 mg/dl; cells 5960/ml / MRI spine / Syringomyelia / ATT and steroid / Not mentioned
15 / Naidoo et al 1991 / Case reports / 14F
36 F / TBM with LMN weakness of lower limbs
TBM with LMN involvement of lower limbs / Weakness paradoxically progressed
Weakness paradoxically progressed / The protein content was 38 g/l / The post-myelogram CT scan showed filling defects in the thecal sac
Myelography at this
stage revealed a partial block in the lower
thoracic and upper lumbar region with diffuse arachnoiditis / Arachnoiditis
Arachnoiditis / ATT and corticosteroids
ATT and corticosteroids and surgical decompression / improved marginally
improved marginally
16 / Fehlings and Bernstein 1992 / Case report / 23M / TBM / Rapid progressive weakness and numbness in both hands (5 weeks later to diagnosis of TBM) / CSF cells 11.7×106/L (95% neutrophils; CSF protein 2.3 g/l / MRI (enhancing extradural lesion compressing the cord from C6-D7),
Syringomyelia (C7-D8) on repeat MRI / Arachnoiditis, syrinx / ATT and steroids, Laminectomy with histopathology (AFB positive); syringo-peritoneal shunt on repeat MRI / Not improved
17 / Kumar et al 1993 / Case report / 23M / TBM / Rapid progressive weakness (bilateral hand weakness and sensory loss below C8/T1 level / CSF protein 5.7 g/l
CSF cells 21/µl / Myelography showed nodular thickening of lumbar roots;
MRI showed enhancing tissue overlying the posterior aspect of cervical and thoracic cord / Arachnoiditis / ATT / Not mentioned
18 / Lin et al, 1994 / Case report / 36/M / TBM with miliary tuberculosis / 2 months, Paraparesis, urinary incontinence / Marked rise in proteins and cells / Intramedullary tuberculoma, arachnoiditis / ATT, corticosteroids, spinal surgery / Improved
19 / Citow
and Ammirati, 1994 / Case report / 31/M / TBM with miliary tuberculosis / 2 weeks, Paraplegia / None mentioned / Intramedullary spinal tuberculoma / ATT, dexamethasone, removal of the
tuberculoma / Improved
20 / Tacconi et al 1995 / Case report / 37/M / TBM / 6 weeks, Paraparesis, paraesthesia and urinary problem / Increase in cells but protein and sugar improved / Intraspinal cord abscesses / ATT, dexamethasone, spine surgery / Slightly improved
21 / Cruickshank and Johnston 1996 / Case report / 19/F / TBM / 3 months, Acute difficulty in walking and right leg
paraesthesia / Not mentioned / Intradural, extramedullary spinal tuberculous granuloma / ATT, spine surgery / Improved
22 / Dehoux et al 1996 / Case report / 58M / TBM / Backache and paraparesis / CSF cells 305/mm3, CSF protein 1500mg/L / MRI spine; Tuberculoma at conus of spinal cord / Intramedullary tuberculoma / ATT and steroid / Partially improved
23 / Hanci M et al 1996 / Case report / 7M / TBM with paraparesis / Simultaneously, suboccipital headache, progressive paraparesis and hypesthesia below T10 / Not reported / MRI spine; Intramedullary abscess at T7 / Intramedullary abscess / ATT, surgery / Improved
24 / Cheng et al 1997 / Case report / 23F / TBM / paraparesis / fluid smear
showed acid-fast bacilli and bacterial culture grew Mycobacterium tuberculosis / MRI spine; Intramedullary spinal cord abscess / Intramedullary abscess / ATT an dexamethasone ,
Thoracic laminectomy / no
neurological recovery
25 / Garg and Karak 1998 / Case report / 30M / TBM / Paraparesis with bladder involvement / CSF protein 0.14 g/l, cells 336 x 106/l, sugar 1.3
mmol/l / MRI spine; Intramedullary tuberculoma in thoracic cord / Tuberculoma / Not known / Not known
26 / Borges et al 1998 / Case report / 26/M HIV positive and multidrug-resistant disseminated tuberculosis / TBM with miliary tuberculosis / Cervical myeloradiculopathy and neck pain / CSF protein 115
mg/dL Tuberculous bacilli in sputum was drug resistant / MRI spine; an intramedullary nodular lesion at the level of C4, / Tuberculoma / 6 drug ATT, ART and corticosteroids / Improved
27 / OÈzates et al 2000 / Case report / 45M / TBM with miliary tuberculosis / 1 year of irregular ATT, Spastic paraparesis and incontinence / Not mentioned / a spinal subdural abscess at T3-T4 level / Abscess / ATT, dexamethasone, shunt and later spinal surgery / Improved
28 / Kaynar et al 2000 / Case report / 30F / TBM (6 year back) / Spastic paraparesis / Not mentioned / MRI; Extensive arachnoiditis and multiloculated syrinx in thoracic cord / Arachnoiditis, syrinx / ATT and decompressive surgery 28for syrinx / Partially improved
29 / Herna´ndez-Albu´ jar et al 2000 / Case report / 27M
HIV-positive / TBM / 3 and half months,
areflexic paraparesis / No significant change / thickening meninges
surrounding the cervical,
thoracic, and lumbar spinal cord; enhancement of the cervical and thoracic meninges, loculations, and obliteration of the subarachnoid space and meningeal tuberculomas, Syringomyelia after 4 months / Arachnoiditis, syrinx / ATT, Methylprednisolone / Not improved
30 / Hui et al 2001 / Case report / 21 F / TBM / 6 months, Flaccid paraparesis / Not mentioned / Arachnoiditis with extramedullary tuberculoma; 1 year syrinx / Arachnoiditis, tuberculoma, syrinx / ATT, dexamethasone, shunt surgery / Partially improved
31 / Kemaloğlu et al 2001 / Case report / 32 M / TBM and pulmonary tuberculosis / 6 months, urinary incontinence, lower limb pain and progressive weakness in legs and impotence / Increase in CSF proteins and cells / conus medullaris tuberculoma / Tuberculoma / ATT, dexamethasone, spinal surgery / Improved
32 / Kobayashi et al 2002 / Case report / 54F / TBM / 30 years, persistent weakness of the left leg and progressive gait disturbance / Protein= 150 mg/dl
cell count= 1 (lymphocyte) / interrupted contrast flow at the level of T-4
syringomyelia in thoracic spinal cord / Arachnoiditis, tuberculoma / spinal surgery
a calcified mass at C6 / Improved
33 / Sumner et al 2003 / Case report / 31M
HIV positive / TBM / 4 weeks, Recurrent myelopathy / protein 153 mg/dL
Cells: 73 white blood
cells/mm3 (81% lymphocytes) / 1-cm enhancing, intradural, extramedullary mass at left T4 / Tuberculoma / ATT, HAART and spinal surgery initially later dexamethasone / Improved
34 / Moghtaderi and Naini 2003 / Case report / 21F / TBM / Paraparesis / CSF cells 2600 leukocytes/µl, protein 240mg/dL, glucose level 40mg/dL / Myelography; Conus and cauda arachnoiditis, Intramedullary tuberculoma / Archnoidiis, tuberculoma / ATT / Not known
35 / Tanriverdi et al 2003 / Case report / 7M
30M
21M / TBM with intramedullary abscess with pulmonary TB
TBM (9 year ago)
TBM (2 year ago) / Paraparesis and bladder (1 month)
Paraparesis(2 year)
Paraparesis with loss of bladder/bowel control(1 week) / Not mentioned
Not mentioned
Not mentioned / MRI; D7 intramedullary cystic ring enhancing mass
MRI; Extensive arachnoiditis,
Multiloculated syrinx
MRI; Homogeneous
enhancing
intradural mass
at T3–L2
Follow-up at 14 month,
Arachnoiditis and
syrinx at T3–10 / Tuberculoma
Arachnoiditis, syrinx
Arachnoiditis, syrinx, abscess / ATT, laminectomy with aspiration of pus (AFB positive)
ATT Laminectomy and syringe-subarachnoidostomy (twice)
Hemilaminectomy+
biopsy / Improved
Partially improved after 2nd surgery
Partially improved
36 / Skendros et al, 2003 / Case report / 27/M / TBM / 3 months, Transverse medullary syndrome at the D4 spinal cord level / Markedly increased protein level (4,500 mg/dl) / An extramedullary mass of the spinal cord, extending from D2 to whole of the dorsal section / Abscess / ATT, dexamethasone, surgical removal / Good recovery
37 / Poon et al 2003 / Case report / 36F / TBM / 6 days, Acute compressive myelopathy / Markedly increased protein level (10 g/d) / extensive subdural
collection over the thoracic spine region with cord compression / Abscess / ATT, dexamethasone, surgical removal / Good recovery
38 / Srivastava and Kochar 2003 / Case series of 16 patients / Not mentioned / TBM / Simultaneous, 3 had asymptomatic spinal arachnoiditis / Not mentioned / cystic arachnoiditis; thoracic subarachnoid space was loculated; clumping of nerve roots and anterior loculations
of the CSF / Arachnoiditis / Not mentioned / Not mentioned
39 / Lolge et al 2004 / Case reports / 35F
58M / TBM, pulmonary TB and spinal tuberculosis T11-12
TBM / 3 year 6months,
Spastic quadriparesis
2 year, Spastic paraparesis / spinal intradural arachnoid cyst at C1 to C3 with extensive myelomalacia
spinal intradural arachnoid cyst at D4 to D7 / Arachnoiditis
Arachnoiditis / Surgery
surgery / Not improved
Improved
40 / Shaharao et al, 2004 / Case report / 6/F / TBM / 6 months, Thoracic myelopathy / Not specified / Intra-medullary tuberculoma / Tuberculoma / ATT, prednisolone / Complete recovery
41 / Chotmongkol et al 2005 / Case report / 17M / TBM / Quadriparesis with bladder involvement / CSF protein 369 mg/dl / MRI; Thoracic cord enhancement at D7 level
Repeat MRI later, CSF loculations at upper cervical level, myelitis / Arachnoiditis, myelitis / ATT, steroid, cervical laminectomy / Died
42 / Blaivas et al, 2005 / Case report / 22/M / TBM / 1 month, Tuberculous radiculomyelits / None reported / Tuberculoma / ATT, corticosteroids / Improved
43 / Roca 2005 / Review of 22 cases / 27 year (median age) / TBM in 17 cases
TBM with Intradural extramedullary tuberculoma of the spinal cord simultaneously in 4 patients / Paraparesis
in all 22 cases (100%), hypoesthesia with a
sensory level in 20 patients (91%), and urinary
sphincter dysfunction in 14 patients (64%). / Variable protein and cells / MRI in 13 and myelography in 9; Intradural extramedullary tuberculoma of the spinal cord in all and syringomyelia in 1 / Tuberculoma, syrinx / ATT, corticosteroid, surgery variably / All patients improved;
17 (77%) remained
with variable degrees of persistent walking difficulty.
44 / Muthukumar et al, 2007 / Case report / 21/M / TBM / 6 months, Myelopathy (paraparesis) / None reported / Intradural extramedullary granuloma / Tuberculoma / ATT, surgery / Improved
45 / Muthukumar and Sureshkumar 2007 / Case report / 27F / TBM / Spastic paraparesis with incontinence / Not reported / MRI spine; Intradural-extramedullary tuberculoma at lower thoracic level with extensive syrinx / Tuberculoma, syrinx / ATT, steroid, decompressive surgery / Partially improved
46 / Moghtaderi et al, 2007 / Case report / 21/F / TBM / 1 month, Paraparesis and vision loss / Not changed / Spinal arachnoiditis / Arachnoiditis / ATT, ventriculo-peritoneal shunt, spinal surgery / Improved
47 / Katchanov et al 2007 / Case reports / 69F / TBM (TB-PCR and culture positive) / Not mentioned / CSF protein 432 mg/dl, cells 230/µl / MRI spine; Syringomyelia in thoracic cord / Syrinx / ATT and steroid / Not mentioned
48 / du Plessis et al 2008 / Case reports / 6months/M
8months/M
3/M / TBM
TBM
TBM / Not mentioned
progressive quadriplegia
weakness of
the left leg / Not mentioned
Not mentioned
Not mentioned / MRI spine
MRI spine; intramedullary ring-enhancing lesion
MRI spine; arachnoiditis with extradural tuberculous abscess / Arachnoiditis
Tuberculoma
Arachnoiditis, abscess / Not mentioned
ATT, ventriculo-peritoneal shunt
Not mentioned / Not mentioned
Not mentioned
Not mentioned
49 / Hristea et al 2008 / Case reports / 20M
44M / TBM
TBM / 4th day, paraplegia developed with asymmetric sensory loss and incontinence, DTRs were absent and plantar extensor
6 months later, spastic paraparesis / Protein 59.8 g/l at 8
Weeks
CSF 8 cells/ml and 43.1g/l protein / MRI spine revealed an obliterated subarachnoidal space in the thoracic and lumbar segments and enhancement of the meninges,
Hyperintense signal T4-T9 of the thoracic spinal cord
multiple intramedullary
lesions at D4, D5—6, D8, D10, and D11 / extensive arachnoiditis , myelitis
Multiple tuberculoma / ATT and corticosteroids
ATT and corticosteroids (both iv and intrthecal) / Improved
Improved
50 / Ozek et al, 2009 / Case report / 18/F / TBM / 6 months, Spastic paraparesis / None reported / An intradural extramedullary en plaque-shaped tuberculoma extending from D1-9 vertebral column / Tuberculoma / ATT, spinal surgery / Marked improved
51 / Calaf et al, 2009 / Case report / 28/M / TBM with multiple tuberculoma / 1 ½ months, Paraplegia / None reported / Intradural-extramedullary tuberculoma / Tuberculoma / ATT, spinal surgery / Not improved
52 / Chitre et al, 2009 / Case report / 6/F / TBM / 5 months, spastic paraparesis / CSF 200 lympho- cytes/mL, sugar 42.8 mg/dL, proteins 29.7 mg/dL / Intramedullary (T9-10) and intracranial tuberculomas / Tuberculoma / ATT, surgery / Improved
53 / Shim et al, 2010 / Case report / 24/M / TBM, pulmonary tuberculosis / 1 month, Thoracic myelopathy / None reported / Intradural, extramedullary tuberculoma &lumbosacral tuberculosis spondylitis with multiple abscesses / Intradural tuberculoma, pott’s spine, abscess / ATT, spinal surgery / Improved
54 / Gul et al, 2010 / Case report / 21/M / TBM / 3 months, Thoracic myelopathy / None reported / intradural-extramedullary tuberculoma, later syringomyelia / Intradural Tuberculoma, syrinx / ATT, prednisolone / Improved with syringo-peritoneal shunt
55 / Choi et al, 2011 / Case report / 31/M / TBM / 12 months, Progressive quadriparesis / None reported / Multiple intradural extramedullary nodular masses at
cervical & dorsal spinal cord; at 3 years
syringomyelia & multiple intradural extramedullary tuberculoma / Intradural tuberculoma, syrinx / ATT, dexamethasone, laminectomy & excision of the mass / Not much improvement
56 / Malhotra et al, 2012 / Case report / 32/F / TBM / 4 months, Progressive, areflexic, sensorimotor paraparesis with bowel & bladder involvement. / None reported / Thoraco-lumbar arachnoiditis / Arachnoiditis / ATT, dexamethasone / None reported
57 / Sundaram et al 2012 / Case report / 37/M (HIV+) / TBM / 6 years, spastic weakness of the right leg / None reported / multiloculated syrinx in the thoracic spinal cord extending from the T2 to the T11 level / Syrinx / ATT (6 years back) / None reported
58 / Das et al, 2012 / Case report / 35/M, / TBM / 1 month, weakness of both lower limbs, retention of urine, involuntary movements / Not reported / Multiple inflammatory granulomas, lacunar infarct in pons, spinal cord compression with edema at D3-D4 level; multiple ring-enhancing lesions in both cerebral hemispheres / Arachnoiditis, cord compression, / ATT, prednisolone / Improved with residual paraparesis
59 / Agarwal et al, 2012 / Case report / 35/M / TBM / 6 months, Spastic paraplegia / Not reported / Extramedullary dorsal tuberculoma (enplaque type) extending from D1- D12 level) / Extramedullary tuberculoma / ATT, spinal surgery / Improved
60 / Saini et al 2012 / Case report / 4/M / TBM with hydrocephalus / At time of diagnosis of TBM, quadriparesis and bladder involvement / Not reported / Cervical intramedullary conglomerate tuberculomas / Intramedullary tuberculoma / ATT, steroid, ventro-peritoneal shunt / improved
61 / Tekin et al, 2013 / Case report / 36/M / TBM with pulmonary tuberculosis / 6 months, paraparesis / Not reported / Intracranial and intramedullary tuberculoma with vertebral
abscess / Tuberculoma, POTT’S spine / ATT / Improved
62 / Pandey et al, 2013 / Case report / 26 F / TBM / 6 weeks, Flaccid quadriparesis / Not reported / long syrinx from C6 to T3 level / Syrinx / ATT, dexamethasone, shunt surgery / Partial improvement
63 / Lawler et al, 2013 / Case report / 12F (HIV+) / A tuberculous cerebellar abscess / 1 year after starting HAAR,T paraparesis and sphincter
dysfunction after improvement in her CD4 count, following antiretroviral therapy / Protein=5.95 g/dl, glucose =2.0 g/dl and 38 lymphocytes/mm3 / Intramedullary conus medullaris tuberculoma / Tuberculoma / ATT and HAART and later on corticosteroids / Improved
64 / Smith et al 2013 / Case report / 45M / TBM / Simultaneous, urinary retention / Protein
1.44 g/l / Enhancement
over the lower thoracic cord / Arachnoiditis / ATT / Improved
65 / Ranganathan and Hogarth, 2013 / Case report / 22/M / disseminated tuberculosis with TBM / 1 month, sudden weakness in all four limbs / protein 0.9 g/L / MRI of the upper cervical spine, showing the enhancing loculated collections surrounding the spinal cord and the brainstem. / Loculated collection / ATT, dexamethasone, shunt surgery with decompression of the craniocervical junction / Improved
66 / Sahu et al, 2014 / Case report / 22M / TBM / 5 months paradoxical, subacute onset sensorimotor paraparesis with urinary urgency / Not reported / ring enhancing intramedullary tuberculoma at D4 level / Tuberculoma / ATT, dexamethasone / Not reported
67 / Das et al, 2014 / Case report / 17M / TBM / 6 months paradoxical, spastic quadriparesis / Not reported / intramedullary tuberculoma at C3-6 level, cerebellar tuberculoma / Tuberculoma / ATT, dexamethasone, shunt surgery and spinal surgery / Improved
68 / Fujimori and Nakashima, 2014 / Case report / 38M / TBM / 2 years, progressive gait disturbance progressed
over 6 years / Not reported / syringomyelia extending from T3 to the conus medullaris / Syrinx / Not reported / Not reported
69 / Sahu et al, 2014 / Case series / 35/ transgender
(HIV+)
40/F
40/M
45/M / TBM?
Miliary TB and TBM?
TBM
TBM / Presenting illness,
sudden-onset lower motor neurone paraplegia and urinary retention
Presenting illness,
acute-onset rapidly progressive weakness of lower limbs and retention of urine
Presenting illness,
acute-onset rapidly progressive weakness of lower limbs and retention of urine
Presenting illness,
Acute quadriparesis / Protein raised (PCR positive for Mycobacterium tuberculosis)
PCR positive for Mycobacterium tuberculosis)
20 cells/ml (50% lymphocytes), protein 200 mg/l
40 cells/ml in the CSF, protein was 440 mg/dl / Diffuse long segment spinal cord signal alteration extending from C7 to the conus. MRI of the brain showed multiple small ring-enhancing lesions.
Diffuse long segment spinal cord signal alteration extending from D1 to the conus. MRI of the brain showed multiple small ring-enhancing lesions.
signal intensity involving the dorsal cord from D6 to D10 levels
ill-defined T2 hyperintensities in the dorsal cord from D2 to D9 levels / Myelitis
Myelitis
Myelitis
Myelitis / ATT and ARV
ATT
ATT with Methyl prednisolone
ATT with Methyl prednisolone / gradually improved over 8 weeks
gradually improved over 6 weeks
improved gradually over 10 weeks
improved gradually over 12 weeks
70 / Aniruddha and Nupur, 2014 / Case report / 2/M / TBM with multiple episodes of shunt malfunction / 6 years, quadriparesis and truncal ataxia / Not reported / cervicodorsal expanding syrinx and dilated 4th ventricle / Syrinx / fresh ventriculopleural shunt / Improved with resolution of syrinx
ATT: Anti-tuberculosis treatment, CSF: Cerebrospinal fluid, D: Dorsal, F: Female, ICP: Intracranial pressure, M: Male, MPS: Methylprednisolone, PR: Paradoxical reaction, TBM: Tuberculous meningitis; CNS: central nervous system; CT: computed tomography; MRI: magnetic resonance imaging; IETSC: intradural extramedullary tuberculoma in spinal cord

References (listed as per appearance in the table)