Torii Hiroaki, Takahashi Toshiyuki, Shimizu Hiroaki, Watanabe Mika, Tominaga Teiji
Department of Neurosurgery, Kohnan Hospital, Sendai, Miyagi, Japan.
Neurol Med Chir (Tokyo). 2004 May;44(5):266-8. doi: 10.2176/nmc.44.266.
A healthy 33-year-old man presented with an intramedullary tuberculoma of the thoracic spinal cord manifesting as a 2-month history of progressive paraparesis and sphincter dysfunction. Magnetic resonance imaging showed ring enhancement of the intramedullary thoracic lesion with perifocal edema. General physical examination was unremarkable with no signs of inflammation except for a positive finding by the tuberculin skin test. Total resection of the intramedullary mass was performed through a posterior myelotomy following T11-12 laminectomy. Histological examination revealed a granulomatous lesion that contained Langhans giant cells, inflammatory cells, and caseating necrosis. Acid-fast bacilli staining of the specimens was positive, and cultures grew Mycobacterium tuberculosis. Postoperatively, the paraparesis and sphincter dysfunction improved sufficiently for the patient to return to his ordinary activities. Intramedullary spinal tuberculoma is rare, but must be considered in the differential diagnosis of spinal cord compression.
一名33岁健康男性因胸段脊髓髓内结核瘤就诊，表现为进行性双下肢轻瘫和括约肌功能障碍2个月。磁共振成像显示胸段髓内病变呈环形强化，周围有水肿。全身体格检查无异常，除结核菌素皮肤试验阳性外无炎症迹象。在T11 - 12椎板切除术后，通过后路脊髓切开术对髓内肿块进行了全切除。组织学检查显示为肉芽肿性病变，包含朗汉斯巨细胞、炎性细胞和干酪样坏死。标本抗酸杆菌染色阳性，培养出结核分枝杆菌。术后，双下肢轻瘫和括约肌功能障碍充分改善，患者能够恢复日常活动。脊髓髓内结核瘤罕见，但在脊髓压迫的鉴别诊断中必须予以考虑。
