Primary tuberculomas of the thoracal spinal cord: Case report

The authors present an unusual case of intramedullary tuberculoma in a HIV-negative patient from the southeast part of Romania who demonstrated no other signs of tuberculous infection. Clinical exam: extreme spastic paraparesis in triple flexion, dorsal pain and bladder and bowel incontinence. Gd enhanced MRI revealed ring enhancing lesion with central hypointensity, suggesting granulomatous pathology. Surgical excision of the intramedullary lesions was carried out followed by anti-tuberculous chemotherapy and Baclofen tablets . !0 days postoperative MRI showed total resolution of the lesion. Two years follow up showed progressive resolution of spasticity. Following surgical excision, the patient improved significantly sensitive and modest the motility and spasticity. The management of this rare lesion is discussed and the literature reviewed

Intramedullary tumors: Clinical, radiological and histological correlations

Intramedullary spinal cord (SC) tumors are relatively rare tumors, accounting for only 2% to 4% ofcentral nervous systemtumors.These tumorsaregenerallyslow-growing tumorsthatcouldbenefitfromsurgical removal. A pre-surgery identification of the tumor histology might improve the surgical management of the tumor and also properly predict the functional outcome after surgery. The neuroimaging techniques, provide crucial information about tumors anatomy. By adding the medical history of the present illness and detailed clinical examination, the imaging data might however be extremely helpful in the prediction of tumor histology. This will allow anappropriate surgical managementofthese lesions and provide pertinent predictors of the functional outcome post-surgery. Therefore, the surgeon can set the patient’s expectations at a realistic level.The present studyis a prospective study,aiming to use combined clinical and imaging data to predictthe intramedullary SC tumor histology. The primary objectiveis to identify the pathognomonic clinical and imaging pattern for eachtumor type.The study was conducted in the Neurosurgery Clinic Emergency Clinic Hospital Bagdasar-Arseni between 2006 and 2009. A total of 36 patients (19 females/17 males) participated. All patients were evaluated for motor, sensory, sphincter, walking and balance functions. MRI assessment was used to determine the presence of an intramedullary SC tumor as well as its characteristics.All histological types have a long history of symptoms, which depends of locations in longitudinal plane. All intramedullary tumors presented spinal cord dilatation on MRI. We confined the clinico-radiological characteristics of each histological type, strongly correlated with histopathological analysis, extensively presented in the paper. By combining a careful medical history, clinical examination and MRI data, we could predict with a reasonable accuracy in preoperative stage the histological type of an intramedullary tumor.&nbsp