Spinal cord tuberculomas are rare compared to intracranial tuberculomas and can be challenging to diagnose particularly in individuals who are not from endemic areas.
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Epidemiology
Only 0.2% of central nervous system tuberculosis shows evidence of spinal cord involvement, and among tuberculosis patients, the incidence is only 2/100,000 1.
It is most frequently seen in young adults and the thoracic part of the cord is mostly affected.
Pathology
Hematogenous dissemination and cerebrospinal fluid infection are most common, however, in a small number of cases, local extension of spinal tuberculosis may be responsible.
Radiographic features
MRI is the modality of choice for assessing spinal cord pathology.
MRI
MRI appearances can change depending on the stages of tuberculoma 1-3.
Early-stage tuberculoma is characterized by a severe inflammatory response that results in extensive surrounding edema. The gel capsule has not properly formed at this point and enhancement following contrast examination is uniform.
When caseation develops the lesion displays a characteristic target sign characterized by central low T1 and T2 signal with a high T2 signal rim with vivid enhancement 2.
Caseous substance creates the target core, but peripheral infective granulation tissues form the high signal rim that enhances on post-gadolinium study 2.
The T2 appearance is particularly helpful in suggesting the diagnosis.
Treatment and prognosis
Antitubercular therapy is still the basis of care, and surgery is typically required to relieve spinal cord compression and enhance neurological function 4.
Differential diagnosis
Common spinal intramedullary tumors such
- spinal astrocytoma
- spinal ependymoma
- spinal hemangioblastoma
- spinal cord metastases
- spinal cord abscess
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