Cannon Hershel W, Weaver Michael, Kaul Anand, Lazim Ahmed
Departments of1Neurosurgery and.
2Pathology, Temple University Hospital, Philadelphia, Pennsylvania.
J Neurosurg Case Lessons. 2023 Mar 13;5(11). doi: 10.3171/CASE22376.
A tuberculosis infection of the central nervous system can present as a localized, intraspinal tuberculoma. These lesions may cause spinal cord compression requiring early identification and surgical decompression to limit deleterious neurological sequelae.
A 28-year-old female with a history of opioid use disorder presented with low-back pain in the setting of trauma with progressive bilateral lower extremity radiculopathy and paraparesis. T1- and T2-weighted magnetic resonance imaging sequences of the spine demonstrated a heterogeneously hyperintense extra-axial epidural mass at T11 with mass effect. Biopsy of the lesion revealed benign soft tissue with necrosis and caseating granulomatous inflammation consistent with tuberculoma. The patient underwent laminectomy and debulking of mass for decompression and was subsequently began antitubercular treatment with good neurological outcome.
To the best of the authors' knowledge, there are only a handful of microbiologically and radiographically confirmed cases of spinal epidural tuberculoma in English literature. These lesions are rare and difficult to clinically and radiographically characterize in the absence of systemic pulmonary TB symptoms. Tuberculoma is an important differential for a spinal epidural mass, particularly because resection with systemic antitubercular treatment results in symptom resolution.
中枢神经系统结核感染可表现为局限性的脊髓内结核瘤。这些病变可能导致脊髓受压，需要早期识别并进行手术减压，以限制有害的神经后遗症。
一名有阿片类物质使用障碍病史的28岁女性，在创伤背景下出现下背部疼痛，并伴有进行性双侧下肢神经根病和轻瘫。脊柱的T1加权和T2加权磁共振成像序列显示T11水平有一个不均匀高信号的轴外硬膜外肿块，伴有占位效应。病变活检显示为良性软组织，伴有坏死和干酪样肉芽肿性炎症，符合结核瘤表现。患者接受了椎板切除术和肿块减压切除术，随后开始抗结核治疗，神经功能恢复良好。
据作者所知，英文文献中仅有少数经微生物学和影像学证实的脊髓硬膜外结核瘤病例。这些病变很罕见，在没有系统性肺结核症状的情况下，在临床和影像学上很难进行特征性诊断。结核瘤是脊髓硬膜外肿块的一个重要鉴别诊断，特别是因为手术切除并进行系统性抗结核治疗可使症状缓解。
