Presentation
Cough for 2 months and lower back pain and numbness for 2 weeks
Patient Data
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Oval, well-defined lesion measuring 1.6* 1.2 cm between the L1 and L2 vertebral level located intradural, extramedullary space demonstrates T1-isointense, T2-hypointense, surrounded by hyper intense rim, and primarily homogenous contrast enhancement in post-gadolinium study with small foci central non-enhancing component.
L5 right neural foraminal narrowing is present along with L5/S1 disc bulging.
Case Discussion
Taking into account the MRI evidence of T2 hypointense with hyperintense rim displaying homogenous enhancement on post contrast is a feature of caseous stages of tuberculoma.
In caseous stages, the post-contrast enhancement is either homogenous or ring-shaped.
In addition to the MRI features that are often seen in caseous tuberculoma, the patient also has matted cervical lymph nodes (not shown) that, when examined with FNAC, showed caseous necrosis. By incorporating this evidence, the diagnosis of intrathecal tuberculoma is confirmed.
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