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播散性肺结核病例中的硬脊膜内髓外结核瘤：一例报告

Intradural extramedullary tuberculoma in a case of disseminated tuberculosis: A case report.

作者信息

Shrivastava Chitranshu, Rathod Tushar Narayan, Shahade Rushikesh Bhanudas, Mohite Akshay Vasant, Hadole Bhushan Sunil, Jain Deepika

机构信息

Department of Orthopedics, KEM Hospital and Seth GS Medical College, Mumbai, Maharashtra, India.

出版信息

Surg Neurol Int. 2024 Dec 27;15:477. doi: 10.25259/SNI_664_2024. eCollection 2024.

DOI:10.25259/SNI_664_2024
PMID:39777166
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11705167/
Abstract

BACKGROUND

Intradural extramedullary tuberculoma of the spinal cord (IETSC) is an exceedingly rare manifestation of tuberculosis (TB) affecting the central nervous system.

CASE DESCRIPTION

A 33-year-old immunocompetent female with disseminated TB, including pulmonary involvement and leptomeningeal tuberculomas, developed progressive paraplegia and urinary incontinence over 2 months. Magnetic resonance imaging revealed diffuse intradural extramedullary soft tissue from C7 to L2 vertebral levels, indicative of abscess formation and severe spinal cord compression. The surgical intervention involved posterior decompression and abscess removal from D7 to L2 vertebral levels, resulting in partial resolution of granulomatous lesions.

CONCLUSION

This case emphasizes the importance of considering IETSC in the differential diagnosis of spinal cord compression in TB-endemic regions. Further research is warranted to elucidate optimal management strategies, including the role of surgical intervention, in improving long-term neurological outcomes for patients with this rare but debilitating form of spinal TB.

摘要

背景

脊髓硬膜内髓外结核瘤（IETSC）是结核病（TB）累及中枢神经系统的一种极为罕见的表现形式。

病例描述

一名33岁免疫功能正常的女性，患有播散性结核病，包括肺部受累和软脑膜结核瘤，在2个月内出现进行性截瘫和尿失禁。磁共振成像显示从C7至L2椎体水平存在弥漫性硬膜内髓外软组织，提示脓肿形成和严重脊髓受压。手术干预包括从D7至L2椎体水平进行后路减压和脓肿清除，导致肉芽肿性病变部分消退。

结论

该病例强调了在结核病流行地区，脊髓压迫的鉴别诊断中考虑IETSC的重要性。有必要进一步开展研究，以阐明优化管理策略，包括手术干预的作用，从而改善这种罕见但使人衰弱的脊髓结核患者的长期神经学预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22b/11705167/5faca1bff290/SNI-15-477-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22b/11705167/74f8fa5dfc93/SNI-15-477-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22b/11705167/3d29730c9689/SNI-15-477-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22b/11705167/8d015a74103c/SNI-15-477-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22b/11705167/c1e6a93a0301/SNI-15-477-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22b/11705167/8a52053749e4/SNI-15-477-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22b/11705167/5faca1bff290/SNI-15-477-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22b/11705167/74f8fa5dfc93/SNI-15-477-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22b/11705167/3d29730c9689/SNI-15-477-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22b/11705167/8d015a74103c/SNI-15-477-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22b/11705167/c1e6a93a0301/SNI-15-477-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22b/11705167/8a52053749e4/SNI-15-477-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e22b/11705167/5faca1bff290/SNI-15-477-g006.jpg

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本文引用的文献

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Clin Case Rep. 2023 Nov 2;11(11):e8131. doi: 10.1002/ccr3.8131. eCollection 2023 Nov.
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A Case of Partial Resection of an Intradural Extramedullary Tuberculoma Resulting in Improvement of Lower Limb Paralysis.1例硬脊膜内髓外结核瘤部分切除术后下肢麻痹症状改善的病例
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Intradural extramedullary tuberculoma of the thoracic spine - A rare case report of paraparesis.
胸椎硬膜内髓外结核瘤——一例截瘫罕见病例报告
Surg Neurol Int. 2021 Apr 8;12:136. doi: 10.25259/SNI_197_2021. eCollection 2021.
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Intradural extramedullary tuberculoma of the spinal cord in patient of tubercular meningitis - an uncommon scenario.结核性脑膜炎患者脊髓硬脊膜内髓外结核瘤——一种罕见情况。
Indian J Tuberc. 2020 Jul;67(3):426-429. doi: 10.1016/j.ijtb.2020.05.001. Epub 2020 May 12.
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Long-term Sequela of Intradural Extramedullary Tuberculoma in the Thoracic Dorsal Spinal Cord: Case Report and Review of the Literature.胸段脊髓硬膜内髓外结核瘤的长期后遗症：病例报告及文献复习
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