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结核性蛛网膜炎：青年成人双下肢轻瘫的罕见病因——病例报告及文献复习

Tubercular arachnoiditis: A rare culprit of paraparesis in a young adult - A case report and review of literature.

作者信息

Kumar Jiwesh, Roy Kaushik, Chakraborty Abhirup, Patra Ritankar

机构信息

Department of Neurosurgery, Nil Ratan Sircar Medical College and Hospital, Kolkata, West Bengal, India.

出版信息

Surg Neurol Int. 2024 Nov 22;15:432. doi: 10.25259/SNI_598_2024. eCollection 2024.

DOI:10.25259/SNI_598_2024
PMID:39640348
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11618825/
Abstract

BACKGROUND

The prevalence of central nervous system tuberculosis (TB) is about 1-2% of all TB cases. Atypical cases like the present case, being interpreted as leptomeningeal metastasis in magnetic resonance imaging (MRI), can pose a dilemma, delaying or even leading to mistreatment.

CASE DESCRIPTION

A 19-year-old male presented with acute onset paraparesis and bowel bladder involvement presented with an MRI lumbar spine suggesting leptomeningeal metastasis from D11-L5 levels who underwent decompression biopsy which on histopathological examination revealed to be tubercular granulomatous infection. Anti-tubercular drug (ATD) started, and significant improvement was seen in the lower limb power and tone. The outcome of treatment has been unpredictable. Previous case studies having neurological deficits due to severe compression, including ours, show good recovery after surgical decompression and ATD regime.

CONCLUSION

Such cases should be managed with high suspicion as they can be easily misdiagnosed to be tumors, leading to mistreatment or delayed treatment.

摘要

背景

中枢神经系统结核（TB）在所有结核病病例中的患病率约为1%-2%。像本病例这样的非典型病例，在磁共振成像（MRI）中被解释为软脑膜转移，可能会造成诊断困境，导致治疗延迟甚至错误治疗。

病例描述

一名19岁男性因急性起病的双下肢轻瘫及膀胱直肠功能障碍就诊，腰椎MRI提示D11-L5节段软脑膜转移，接受了减压活检，组织病理学检查显示为结核性肉芽肿感染。开始使用抗结核药物（ATD）治疗后，下肢肌力和肌张力有明显改善。治疗结果难以预测。既往包括我们的病例研究在内，因严重压迫导致神经功能缺损的病例，在手术减压和ATD治疗后均显示出良好的恢复。

结论

此类病例应高度怀疑，因为它们很容易被误诊为肿瘤，从而导致错误治疗或治疗延迟。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b316/11618825/0fa594682eec/SNI-15-432-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b316/11618825/a0e562d08278/SNI-15-432-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b316/11618825/8e0e36fb7869/SNI-15-432-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b316/11618825/ef9df7ef34b2/SNI-15-432-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b316/11618825/0fa594682eec/SNI-15-432-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b316/11618825/a0e562d08278/SNI-15-432-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b316/11618825/8e0e36fb7869/SNI-15-432-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b316/11618825/ef9df7ef34b2/SNI-15-432-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b316/11618825/0fa594682eec/SNI-15-432-g004.jpg

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