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The incidence of tuberculosis (TB) is increasing in both developing and developed worlds, entailing enormous mortality and morbidity. CNS TB has a wide and protean clinical spectrum, raising important problems in diagnosis and institution of empirical antituberculous therapy (ATT). Tuberculous radiculomyelitis (TBRM) is a life-threatening complication of neurological TB that is rarely reported. In literature, TBRM is often secondary to downward extension of tuberculous meningitis, or occasionly secondary to osteitis.1 Primary TBRM appears rare and probably arises as a localised arachnoiditis from a primary focus in the meninges.2 Efficient diagnosis by detection of Mycobacterium tuberculosis (MTB) DNA can provides a rapid diagnosis of CNS TB and may be life-saving. Here, we report four cases with atypical CSF features; diagnoses were established on positive test of MTB DNA.
A 47-year-old woman, who had suffered from a brief febrile illness without neurological and respiratory manifestation 2 weeks previously, experienced an acute bilateral lower-limb weakness and paraesthesia with urinary retention in January 2007. She had been unable to walk unaided, and catheterisation was required. MRI of the thoraco-lumbar spinal cord (figure 1A–E) showed increased T2 intramedullary signals and ring enhancements below spinal cord level Th11, with nodular enhancement of the corda enquina. CSF examination showed normal. She underwent steroid pulsed treatment that did not show any effect. By the middle of March, she complained of progressive weakness and sharp pains in both legs with burning dysaesthesia of …
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; not externally peer reviewed.