Spinal intramedullary tuberculoma in a 3-year-old girl

Background: Spinal intramedullary tuberculoma (IMT) is a rare manifestation of extrapulmonary tuberculosis (TB). Presentation of TB in the pediatric age group is a significant contributor to mortality. Case Description: A young vaccinated girl presented to the neurosurgery department with difficulty walking and urinary incontinence. A magnetic resonance imaging performed outside the hospital showed a hyperintense intramedullary lesion extending from T6 to T9. The patient underwent T6–T9 laminoplasty with intramedullary lesion decompression under neuromonitoring. The dense adherence of the lesion to the cord and nerve roots permitted only debulking. Histopathological examination confirmed the diagnosis of tuberculoma. The patient was started on antitubercular treatment and was then subsequently discharged. After 8 months, the patient was reviewed and showed improvement in her symptoms and complete resolution of the lesion on imaging. The patient has now developed hydrocephalus on the latest computed tomography imaging, which may be due to tubercular meningitis or arachnoiditis. Conclusion: Complete resolution of spinal IMT is possible with a combined treatment approach.

Intramedullary glioblastoma multiforme in young patients: A case report and brief review

Cervical glioblastoma multiforme (GBM) is rare, and its early diagnosis and management is crucial to patient survival. In the young population, it’s even more difficult to diagnose. The main challenges in GBM therapy are associated with the location of the disease and its complex and heterogeneous biology. Here, we present a case of a 35-year-old female patient admitted due to complain of pain in her right lower limb. She reported the evolution of the condition for dysesthesia in upper limbs and lower limbs 4 weeks ago. MRI showed an intramedullary lesion extending from C2 to C5. The patient was managed surgically. The purpose of this report is to document this rare condition, especially in the young age group, and reveal the current knowledge regarding intramedullary GBM.

SPINAL TUBERCULOSIS REVISTED : STUDY OF CLINICALPRESENTATION, DIAGNOSIS, AND MANAGEMENT OF SPINAL TUBERCULOSIS IN A TERTIARY CARE CENTRE IN SOUTH INDIA

Introduction: Tuberculosis is a disease that affects mostly young individuals in their productive formative years. The risk is 20–37 times greater in HIV co- infected individuals than among those without HIV. Spinal tuberculosis is uncommon in the western world as compared to Asian countries. But it is e-emerging in Western Countries due to the HIV pandemic. Aim Of The Study: This study analysis the clinical presentation, neuroradiology manifestations, and treatment aspects of spinal tuberculosis. Design: Observational study. Materials And Methods: Patients admitted in government Royapettah hospital during the year July 2018- February 2020 in the general medical ward with the diagnosis of paraplegia / paraparesis and subsequently diagnosed with spinal tuberculosis were recruited for the study. 35 of them were diagnosed to have spinal tuberculosis after Inclusion and exclusion criteria. Detailed history was taken, examination was done and appropriate imaging (MRI Spine, CT Chest) was taken. Results: 1 (2.9 %) patient had intramedullary lesion in the form of longitudinally extensive transverse myelitis. 34 (97.1 %) patients had extra medullary lesion. 26 (74.3 %) patients underwent medical management. All of them were started on CAT I ATT DOTS regimen along with steroids. 9 (25.7 %) of them underwent both surgical and medical management. Conclusion: The prime aim of treatment of spinal tuberculosis is prevention of deformity so that patients can have a better quality of life. Paramount to this is a high index of suspicion, early detection and initiation of treatment. A holistic treatment approach in all cases of spinal tuberculosis is needed to prevent this dreaded complication.

A Case of Diffuse Multicentric Metachronous Astrocytoma of Temporoinsular and Intramedullary Location

Multiple gliomas are rare glial tumors with a histology that is typically consistent with high-grade gliomas. A distinction is made between multifocal and multicentric gliomas according to criteria of anatomical continuity, as well as between synchronous and metachronous gliomas according to chronological time of onset. We present the case of a professional saxophonist with a left temporoinsular lesion who underwent awake craniotomy with monitoring of verbal and musical ability as well as primary sensory and motor cortices. Histopathological study revealed an isocitrate dehydrogenase 1 (IDH)-mutant diffuse astrocytoma. After 4 years of complete oncological remission, the patient developed impaired proprioception in all four extremities. An intramedullary lesion was detected at the level of C4 consistent with an IDH wild-type diffuse astrocytoma. We highlight the singularity of this case as it involved two low-grade glial lesions, separated in time (metachronous) and location (multicentric), as well as genetic differences between both lesions (IDH mutant and wild type).

Autonomic dysreflexia associated with cervical spinal cord gliofibroma: case report

Background Autonomic dysreflexia (AD) is an abnormal reflex of the autonomic nervous system normally observed in patients with spinal cord injury from the sixth thoracic vertebra and above. AD causes various symptoms including paroxysmal hypertension due to stimulus. Here, we report a case of recurrent AD associated with cervical spinal cord tumor. Case presentation The patient was a 57-year-old man. Magnetic resonance imaging revealed an intramedullary lesion in the C2, C6, and high Th12 levels. During the course of treatment, sudden loss of consciousness occurred together with abnormal paroxysmal hypertension, marked facial sweating, left upward conjugate gaze deviation, ankylosis of both upper and lower extremities, and mydriasis. Seizures repeatedly occurred, with symptoms disappearing after approximately 30 min. AD associated with cervical spinal cord tumor was diagnosed. Histological examination by tumor biopsy confirmed the diagnosis of gliofibroma. Radiotherapy was performed targeting the entire brain and spinal cord. The patient died approximately 3 months after treatment was started. Conclusions AD is rarely associated with spinal cord tumor, and this is the first case associated with cervical spinal cord gliofibroma. AD is important to recognize, since immediate and appropriate response is required.

Pediatric spinal dermoids - the silent legacy of dysraphism: Diagnosis, management and prognosis – a case series with review of literature

Paediatric spinal dermoids are a subtype of cutaneous inclusion tumours of the spine consisting of ectodermal derivatives. They are relatively rare conditions with associated with the stigmata of spinal dysraphism with possible devastating consequences. We present a case series, in which we study the clinical, radiological and surgical aspects and follow up of the tumour in the last one year. All patients presented with either para or tetraplegia with or without sensory involvement. Contrast MRI was done in all cases, of which 3 were intradural extramedullary lesions and one was intramedullary lesion. The age ranged from 1 year to 4 years. 2 cases were associated with tethering of cord, 2 cases with dermal sinus and another with dandy walker malformation. One case had infected discharging sinus with dermoid. Gross total excision of tumour was done in all cases with Neuro monitoring. All had good post operative outcome without worsening of deficits. All patients received rehabilitation. Follow up study ranged from 3 months to 11 months. No residual tumour noted in follow up MRI.