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The clinical manifestations of neurofibromatosis type-1 have in common the presence of neurofibromas, schwannomas and café-au-lait macules, which can potentially appear within any organ system of the body, involving primarily the skeleton, skin and soft tissues. The spinal thoracic tuberculoma in neurofibromatosis is exceptional. We report here, the case of a 31-year-old male with neurofibromatosis type-1 who presented a year agoa spinal thoracic pain. The evolution was marked by the appearance of a dorsal para-vertebral mass, progressively increasing in volume for 03 months. Neurological Examination revealed normal muscle bulk and tone, and power was grade 5/5. Deep tendon reflexes were brisk and the Babinski sign was present. The sensory deficit was present below the D9 level. The remainder of the examination found a voluminous dorsal para vertebral mass ovoid, renitent, and adhering to the superficial and the deep planes. There were also "café-au-lait" spots disseminated on his body. The imagery showed a formation with respect to D11-D12, isointense on T1 and T2, heterogeneously enhanced after contrast with central necrosis, with a foraminal starting point measuring 85x78x66 mm, with external canal extension. Laminectomy D11-D12 was performed with incomplete excision of the lesion. The histological examination showed casein-follicular vertebral tuberculosis, with secondary abdominal changes. Then the patient was put on anti-bacillary drugs. The evolution was marked two weeks later by the reappearance of the back pain and the back mass. On the 42nd day of treatment, the patient had a febrile consciousness disorder with a GCS of 8, right mydriasis and meningeal stiffness. Paraclinic investigations revealed tuberculosis meningoencephalitis, responsible for an active ventricular hydrocephalus associated with a left temporoparietal extrudal hematoma. An external ventricular shunt was performed as well as a left temporoparietal extrudal hematoma evacuation. The patient died 7 days later in a poly visceral failure chart. [ABSTRACT FROM AUTHOR]

The clinical manifestations of neurofibromatosis type-1 have in common the presence of neurofibromas, schwannomas and cafe`-au-lait macules, which can potentially appear within any organ system of the body, involving primarily the skeleton, skin and soft tissues. The spinal thoracic tuberculoma in neurofibromatosis is exceptional. We report here, the case of a 31-year-old male with neurofibromatosis type-1 who presented a year agoa spinal thoracic pain. The evolution was marked by the appearance of a dorsal para-vertebral mass, progressively increasing in volume for 03 months. Neurological Examination revealed normal muscle bulk and tone, and power was grade 5/5. Deep tendon reflexes were brisk and the Babinski sign was present. The sensory deficit was present below the D9 level. The remainder of the examination found a voluminous dorsal para vertebral mass ovoid, renitent, and adhering to the superficial and the deep planes. There were also "café-au-lait" spots disseminated on his body. The imagery showed a formation with respect to D11-D12, isointense on T1 and T2, heterogeneously enhanced after contrast with central necrosis, with a foraminal starting point measuring 85x78x66 mm, with external canal extension. Laminectomy D11-D12 was performed with incomplete excision of the lesion. The histological examination showed casein-follicular vertebral tuberculosis, with secondary abdominal changes. Then the patient was put on anti-bacillary drugs. The evolution was marked two weeks later by the reappearance of the back pain and the back mass. On the 42nd day of treatment, the patient had a febrile consciousness disorder with a GCS of 8, right mydriasis and meningeal stiffness. Paraclinic investigations revealed tuberculosis meningoencephalitis, responsible for an active ventricular hydrocephalus associated with a left temporoparietal extrudal hematoma. An external ventricular shunt was performed as well as a left temporo-parietal extrudal hematoma evacuation. The patient died 7 days later in a poly visceral failure chart.

Abstract Background The post-partum period is a risk factor for tuberculosis (TB), possibly including the period after miscarriage as illustrated here. This case demonstrates how non-specific symptoms can hide widely disseminated TB. Case presentation A healthy 26-year-old female with a history of recent miscarriage presented to the emergency department with non-specific symptoms of headache, abdominal pain, and sub-acute fevers. She had immigrated to the United States from the Marshall Islands 9 years prior. Two months prior to presentation she had a miscarriage at 18 weeks of pregnancy. On admission, transvaginal ultrasound revealed retained products of conception and abdominal computed tomography revealed findings consistent with tubo-ovarian abscesses and peritonitis. The obstetrics and gynecology service performed dilation and curettage (D&C) to remove retained products of conception. Acid-fast bacilli cultures from cerebrospinal fluid as well as specimens from D&C and intra-abdominal abscesses subsequently all grew TB. She was diagnosed with TB meningitis, peritonitis, endometritis, and tubo-ovarian abscesses. Her treatment course was complicated by a paradoxical response resulting in a spinal tuberculoma causing lower extremity weakness. The tuberculoma was treated with surgical decompression as well as continuation of treatment with anti-tubercular chemotherapy and steroids. Conclusion Disseminated and extrapulmonary TB can present with non-specific symptoms. Recognition of risk factors for TB is critical for prompt diagnostic evaluation and treatment of this deadly disease. A paradoxical reaction needs to be taken into consideration when any new neurological symptoms occur during TB treatment.

Background: The post-partum period is a risk factor for tuberculosis (TB), possibly including the period after miscarriage as illustrated here. This case demonstrates how non-specific symptoms can hide widely disseminated TB.Case Presentation: A healthy 26-year-old female with a history of recent miscarriage presented to the emergency department with non-specific symptoms of headache, abdominal pain, and sub-acute fevers. She had immigrated to the United States from the Marshall Islands 9 years prior. Two months prior to presentation she had a miscarriage at 18 weeks of pregnancy. On admission, transvaginal ultrasound revealed retained products of conception and abdominal computed tomography revealed findings consistent with tubo-ovarian abscesses and peritonitis. The obstetrics and gynecology service performed dilation and curettage (D&C) to remove retained products of conception. Acid-fast bacilli cultures from cerebrospinal fluid as well as specimens from D&C and intra-abdominal abscesses subsequently all grew TB. She was diagnosed with TB meningitis, peritonitis, endometritis, and tubo-ovarian abscesses. Her treatment course was complicated by a paradoxical response resulting in a spinal tuberculoma causing lower extremity weakness. The tuberculoma was treated with surgical decompression as well as continuation of treatment with anti-tubercular chemotherapy and steroids.Conclusion: Disseminated and extrapulmonary TB can present with non-specific symptoms. Recognition of risk factors for TB is critical for prompt diagnostic evaluation and treatment of this deadly disease. A paradoxical reaction needs to be taken into consideration when any new neurological symptoms occur during TB treatment. [ABSTRACT FROM AUTHOR]

This article, published in the journal Neurology & Clinical Neuroscience, discusses the use of the "target sign" as a diagnostic clue for spinal tuberculoma. The article presents a case study of a 53-year-old male patient who presented with symptoms such as weakness, numbness, and weight loss. The patient underwent spinal MRI, which revealed a lesion with a target sign appearance, suggesting spinal tuberculoma. Additional imaging showed nodules and edema in the brain and lungs, confirming the diagnosis of disseminated tuberculosis. The patient was treated with anti-tuberculosis medications and corticosteroids, and his symptoms resolved after two months. The article concludes that the target sign can be a useful diagnostic indicator for spinal tuberculoma. [Extracted from the article]

Disseminated tuberculomas in the brain and spinal cord are rare. To the best of our knowledge, only nine cases of spinal intra-medullary tuberculomas with cranial involvement have been reported till date. However, involvement of all levels in the spinal cord, brain stem with pan lobar involvement of the cerebrum and cerebellum has not been reported so far. We present such a case of a 12-year-old boy with history of pulmonary tuberculosis, who presented with gradual onset of quadriparesis and generalized seizures. We have discussed the unusual clinical presentation and the temporal changes in magnetic resonance imaging features along with clinical response to treatment. In cases reported so far, the plan of surgical versus medical management has been opted for variably, in cases of spinal intra-medullary involvement with acute neurological deficit. The decision is even more difficult in multilevel spinal intra-medullary tuberculomas. Our patient showed good clinico-radiological improvement with medical management. [ABSTRACT FROM AUTHOR]

Unlabelled: Introduction: Intra-medullary spinal tuberculoma is a rare form of tuberculosis, with an incidence of only two in 100,000 patients with tuberculosis. We present a case of intra-medullary tuberculoma from Pakistan, which was diagnosed by radiological findings and analysis of cerebrospinal fluid using polymerase chain reaction testing.Case Presentation: We present the case of a 28-year-old Sindhi male with intra-medullary tuberculoma of the spinal cord at the C3 level. Our patient was treated solely with anti-tubercular drug therapy with no surgical intervention.Conclusions: We discuss the possible clinical management of such rare cases, considering both chemotherapeutic and surgical options. Additionally, diagnostic procedures and findings are discussed; we suggest cerebrospinal fluid analysis via polymerase chain reaction and gadolinium-diethylenetriamine pentaacetic acid magnetic resonance imaging as important chemical and radiological tests to be performed in such cases. [ABSTRACT FROM AUTHOR]

Intramedullary spinal tuberculosis is a clinical curiosity. A 19-year-old female was diagnosed and treated for lumbosacral myxopapllary ependy moma (MPE). Three years later, she presented with back pain and hypoesthesia of the left upper limb. Besides revealing local recurrence, the MRI demonstrated a fresh lesion in the cervicomedullary area. The latter was operated and the histopathology revealed a tuberculoma. [ABSTRACT FROM AUTHOR]

Central nervous system (CNS) tuberculosis is an unusual entity of tuberculosis. It usually results from rupture of superficial infective focus. Here, we report a rare case of concurrent intracranial and intramedullary spinal cord tuberculomas in an 18-year-old woman. The patient was presented with headache, diplopia, malaise, weight loss and intermittent fever. She improved well on antituberculous drugs without neurosurgical excision of the lesions. We emphasize that, in endemic areas of tuberculosis, such as Turkey, in the presence of fever, night sweats, diplopia and focal neurological deficits, one should not rule out the existence of CNS tuberculosis. Also not all cases of CNS require surgical intervention. [ABSTRACT FROM AUTHOR]