Tuberculoma in the Medulla Oblongata and Medulla Spinalis:Two Case Reports

Year 2013, , 442 - 445, 01.04.2013

Salih Gülşen Hakan Caner

https://doi.org/10.5152/balkanmedj.2013.8985

Abstract

Tuberculoma in the Medulla Oblongata and Medulla Spinalis:Two Case Reports

Abstract

Background: Central nervous system tuberculosis remains a prevalent problem in developing countries. Also, this disease has been an important problem in developed countries due to the increased incidence of acquired immunodeficiency syndrome. Tuberculosis of the central nervous system is seen in 10% of immunocompetent patients with primary tuberculosis. Case Report: We report two patients with tuberculoma in the central nervous system. The first case had a lesion located in the medulla oblongata, and the second case had a lesion in the medulla spinalis between the 5th cervical and 1st thoracic vertebral level. Both of these patients underwent surgery. Conclusion: CNS tuberculomas may not always show typical magnetic resonance imaging (MRI) signs, but when a neurosurgeon encounters a brown-yellow rubber-like lesion that is easily extirpated from the glial tissue, tuberculoma should be considered; anti-tuberculous and corticosteroid therapy should be initiated as soon as possible to prevent meningitis and the immune-mediated destructive effects of tuberculosis on the CNS. Whether or not anti-tuberculous therapy is continued can be decided upon by following definitive pathologic diagnosis. Turkish Başlık Medulla Spinalis ve Medulla Oblongata İçinde Tüberkülom: İki Olgu Sunumu Arkaplan: Merkezi sinir sistem tüberkülozu gelişmekte olan ülkelerde yaygın bir sorun olmaya devam etmektedir. Bu hastalık, edinilmiş immün yetmezlik sendromunda insidans artışı nedeniyle gelişmiş ülkelerde de önemli bir sorun olmaktadır. Merkezi sinir sisteminin tüberkülozu primer tüberkülozlu immünokompetan hastaların %10'unda görülmektedir. Olgu Sunumu: Merkezi sinir sisteminde tüberkülomu olan iki olgu sunmaktayız. İlk vakada lezyon medulla oblongatada yerleşikti ve ikinci vakada 5. servikal ve 1. torakal vertebra seviyesi arasında medulla spinaliste bir lezyon vardı. Bu hastaların ikisi de ameliyat edildi. Sonuç: MSS tüberkülomları her zaman tipik manyetik rezonans görüntüleme (MRG) bulguları göstermeyebilir, ancak beyin cerrahı kolayca glial dokudan çıkarılan, sarı-kahverengi kauçuk benzeri bir lezyonla karşılaştığında, tüberkülom düşünülmelidir; menenjiti ve MSS üzerinde tüberkülozun immün-aracılı yıkıcı etkilerini önlemek için anti-tüberküloz ve kortikosteroid tedavisi mümkün olan en kısa sürede başlanmalıdır. Anti- tüberküloz tedaviye devam edilip edilmeyeceğine kesin patolojik tanıyı takiben karar verilebilir.

Keywords

Medulla oblongata, spinal cord, meningitis, oedema, tuberculomas

References

• Centers for Disease control: TB elimination revisited: Obstacles, opportunities, and a renewed commitment. MMWR Morb Mortal Wkly Rep 1999;48:1-13.
• Udani PM, Parekh UC, Dastur DK. Neurological and related syndromes in CNS tuberculosis. Clinical features and pathogenesis. J Neurol Sci 1971;14:341-57. [CrossRef]
• Bass JB Jr, Farer LS, Hopewell PC, O’Brien R, Jacobs RF, Ruben F, et al. Treatment of tuberculosis and tuberculosis infection in adults and children. American Thoracic Society and The Centers for Disease Control and Prevention. Am J RespirCrit Care Med 1994;149:1359-74. [CrossRef]
• Dastur DK, Lalitha VS, Prabhakar V. Pathological analysis of intracranial space -occupying Lesions in 1000 cases including children. Part 1.Age sex and pattern; and the tuberculomas. J Neurol Sci 1968;6:575-92. [CrossRef]
• Citow JS, Ammirati M. Intramedullary tuberculoma of the spinal cord. Case report. Neurosurg 1994;35:327-30. [CrossRef]
• Rao GP. Spinal intramedullary tuberculous lesion: medical management.Report of four cases. J Neurosurg 2000;93:137-41.
• Bargalló J, Berenguer J, García-Barrionuevo J, Ubeda B, Bargalló N, Cardenal C, et al. The “target sign”: is it a specific sign of CNS tuberculoma? Neuroradiology 1996;38:547-50. [CrossRef]
• Welchman JM. Computerised tomography of intracranial tuberculomata. Clin Radiol 1979;30:567–73. [CrossRef]
• Selvapandian S, Rajshekhar V, Chandy MJ, Idikula J. Predictive value of computed tomography-based diagnosis of intracranial tuberculomas. Neurosurg 1994;35:845-50. [CrossRef]
• Gupta RK, Jena A, Singh AK, Sharma A, Puri V, Gupta M. Role of magnetic resonance (MR) in the diagnosis and management of intracranial tuberculomas. Clin Radiol 1990;41:120-7. [CrossRef] Kim TK, Chang KH, Kim CJ, Goo JM, Kook MC, Han MH. Intracranial tuberculoma: comparison of MR with pathologic findings. Am J Neuroradiol 1995;16:1903-8.
• Dastur HM. Diagnosis and neurosurgical treatment of tuberculous disease of the CNS. Neurosurg Rev 1983;6:111-17. [CrossRef]
• MacDonnell AH, Baird RW, Bronze MS. Intramedullary tuberculomas of the spinal cord: case report and review. Rev Infect Dis 1990;12:432-39. [CrossRef]
• Tegeris AS. Solitary tuberculoma of the medulla oblongata; case report. Pediatrics 1958;21:370-4.
• Halasy M, Lehoczky T. Case of tuberculoma of medulla oblongata cured by isoniazid. Orv Hetil 1957:10:5- 6.
• Deeb Al SM, Sharif H, al Moutaery K, Biary N. Intractable hiccup induced by brainstem lesion. J Neurol Sci 1991;103:144-50. [CrossRef]
• Bagga A, Kalra V, Ghai OP. Intracranial tuberculoma-evaluation and treatment. Clin Pediatr 1998;10:487-90.
• Artico M, De Caro GM, Carloia S, Salvati M, D’Ambrosio M, Delfini R. Advances in diagnosis, treatment and prognosis of intracerebraltuberculomas in the last 50 years. Report of 21 cases. Neurochirurgie 1999;45:129-33.
• Arseni C. Two hundred and one cases of intracranial tuberculoma treated surgically. J Neurol Neurosurg Psychiatry 1958;21:308-11. [CrossRef]
• Awada A, Daif AK, Pirani M, Khan MY, Memish Z, Al Rajeh S. Evolution of brain tuberculomas under standard antituberculous treatment. J Neurol Sci 1998;156:47-52. [CrossRef]