Presentation
Bilateral upper and lower limb weakness.
Patient Data
Right pareital, temporal, left thalamic and left frontal small enhancing nodules. The nodules showed small hypointense center. No surrounding edema or mass effect.
Right deep cervical large enhancing abscess showing heterogeneous enhancement and internal necrosis (which could represent amalgamated tuberculous deep cervical lymph nodes), those abscesses extend via the neural exit foramina to spread intraspinally forming large abscess compromising the spinal canal and significantly compressing the cervical cord.
- diffuse leptomeningeal thickening and enhancement with thickening and enhancement of the cauda aquina nerve roots
- an inflammatory process seen at L4-5 inter-spinous joint with an intramuscular abscess collection
- an extensive inflammatory process involving the lower sacral and coccygeal segments with vertebral osteomylities, associated with adjacent intraspinal and extra-spinal abscesses. The extra-spinal abscess extends through a sinus tract to the skin surface.
Case Discussion
The cervical lesion was biopsied and revealed caseating granulomatous disease, no malignancy.
The case illustrates cerebral involvement of TB in the form of small scattered granulomas showing small center of low signal.
It also shows extensive spinal involvement, mainly at the sacrococcygeal region extending to the skin surface.