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논문 기본 정보
- 자료유형
- 학술저널
- 저자정보
- 발행연도
- 2015.1
- 수록면
- 5 - 11 (7page)
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Objective: Spinal intramedullary tuberculoma (SIMT) is rare, accounting for 2/100,000 cases of tuberculosis and only 0.2% of all cases of central nervous system(CNS) tuberculosis. We share our experiences of 11 cases of this entity for improving diagnosis and conceptualize the management of this rare disease.
Methods: The clinical profile, radiological data and management of 11 cases of SIMT which were managed either conservatively or by surgical intervention during last 27 years (1987-2014) were analysed.
Results: Male:female ratio was 1.75:1. Five cases had associated pulmonary Koch’s. Most common site was thoracic cord. Two cases had concurrent multiple intracranial tuberculoma. Most common presentation was paraparesis. X-ray myelography was performed in two patients in the initial period of study suggesting intramedullary pathology. In the subsequent nine cases who had magnetic resonance imaging (MRI), seven showed typical ‘‘target sign’’ and conglomerate ring lesion. Out of 8 surgically managed patients, 6 cases improved rapidly and in 2 patients gradual improvement was seen in follow-up. Most common indication of surgical excision was rapid neurological deterioration followed by diagnosis in doubt. Histopathology confirmed tuberculous etiology of the intramedullary lesion in all. Clinical and radiological improvement was seen in all 3 conservatively managed patients in follow-up.
Conclusion: MRI findings of SIMT were specific and proven histologically correct. Surgical intervention may be indicated if there is no response to chemotherapy, the diagnosis is in doubt, or there is a rapid deterioration in neurological function because surgical outcome is good in these circumstances.
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참고문헌 (28)
참고문헌 신청
Abercrombie J. / 1828 / Pathological and practical researches on disease of the brain and the spinal cord / Waugh and Innes :371~372
Alessi G. / 2003 / Combined spinal tuberculous empyema and intramedullary tuberculoma in an HIVpositive patient / Eur Radiol 13:1899~1901
Arslantas A. / 2002 / Intramedullary tuberculoma of spinal cord / J Postgrad Med 48(1):54~55
Cascino J. / 1956 / Tuberculoma of spinal cord / JAMA 162(5):461~462
Citow JS. / 1994 / Intramedullary tuberculoma of the spinal cord : Case report / Neurosurgery 35:327~330
Alessi G. / 2003 / Combined spinal tuberculous empyema and intramedullary tuberculoma in an HIVpositive patient / Eur Radiol 13:1899~1901
Arslantas A. / 2002 / Intramedullary tuberculoma of spinal cord / J Postgrad Med 48(1):54~55
Cascino J. / 1956 / Tuberculoma of spinal cord / JAMA 162(5):461~462
Citow JS. / 1994 / Intramedullary tuberculoma of the spinal cord : Case report / Neurosurgery 35:327~330
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In Korea, tuberculosis is still common disease. Central nervous system tuberculosis can manifest in a variety of forms, including tuberculous meningitis, tuberculous cerebritis, tuberculoma, tuberculous abscess, and miliary tuberculosis. Although intra-axial tuberculomas are the more common type of CNS tuberculosis, extraaxial lesions are rarely encountered. En plaque tuberculoma is an extremely rare presentation of intracranial tuberculosis with mimicking primary or secondary meningeal neoplasia. We describe a rare case of an en plaque tuberculoma accompanied by tuberculous meningitis and tuberculomas.
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