Source: Annual Congress 2006 - Clinical aspects of tuberculosis
Disease area: Respiratory infections

Abstract

Aims: The study analyzes the difficulties of diagnosis and treatment in the rare cases of TB involvement of medulla and meningeal spine.
In 6 years, from 141 patients with tuberculous meningitis, we found 2 myelomeningitis as singular localization.
Case report: 24 yeared woman (no history of tuberculosis) presented bilateral crurosciatalgia, sensitivo-motor paraparesis and mild sphincter dysfunction. The lumbar myelography and cervicothoracal MRI excluded a significant external compression but the cerebrospinal fluid examination (510 white cells/mm3, 100% lymphocytes, protein 3,01mg/dl, glucose 0,55mg/dl) confirmed the TB etiology. Chest-Xray showed bilateral hilar nodes and no other specific lesions. Antituberculous treatment associated with corticosteroids and vitamins determined a significant improvement of the symptomatology after 1 month.
The study demonstrates, from our statistic and literature, that this localization is very rare. We analyze which are the essential steps to establish the diagnosis: discrete signs in MRI (loculation and obliteration of subarachnoidian space with linear intradural enhancement) and complete examination of cerebrospinal fluid. The study analyzes the pitfalls in differential diagnosis and the indications for surgical treatment.
Conclusion: Despite the fact that it is rare, this localization of tuberculosis must be known by the physicians, every symptom of neurological palsy must determine a complete spinal exploration.

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Citations should be made in the following way:
D. Gramada, F. M. Gramada, E. Miftode, M. Grigoras, N. Ianovici, V. Luca, N. Albert (Iasi, Romania). Tuberculous myeloarachnoiditis: pitfalls in diagnosis and treatment. Eur Respir J 2006; 28: Suppl. 50, 829

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