Presentation
Patient diagnosed to have pulmonary tuberculosis on ATT with insidious onset of quadriparesis
Patient Data
Extensive nodular enhancing exudates coating the entire spinal dura-arachnoid sheath extending from the cranio-vertebral junction all the way till the conus. These exudates extend along the nerve sheaths of multiple dorsal nerve roots and along the cauda equina nerve roots with features of cauda equina arachnoiditis.
Long segment intraspinal tubercular abscess along the posterior intradural space from D1-D12 vertebral levels.
Long segment holocord T2 hyperintensity with cord swelling involving the cervical and dorsal cord suggesting tuberculous myelitis.
Contrast enhanced MRI brain shows enhancing exudates limited to the interpeduncular cistern.
Also seen right sided empyema and lung changes in keeping with tuberculosis.
Case Discussion
Tuberculous myelitis can be either due to hematogenous spread of infection or direct spread from an adjacent focus. Findings include cord swelling , edema and T2 hyperintensity which can be long segment or localized to the focus of infection. The presence of intra dural abscess or arachnoiditis and other stigmata of tuberculosis helps establishing the imaging diagnosis and differentiates it from other causes of intra medullary T2 hyperintensity as transverse myelitis.