Tubercular arachnoiditis: A rare culprit of paraparesis in a young adult - A case report and review of literature.

Surgical neurology international Pub Date : 2024-11-22 eCollection Date: 2024-01-01 DOI:10.25259/SNI_598_2024

Jiwesh Kumar, Kaushik Roy, Abhirup Chakraborty, Ritankar Patra

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Abstract

Background: The prevalence of central nervous system tuberculosis (TB) is about 1-2% of all TB cases. Atypical cases like the present case, being interpreted as leptomeningeal metastasis in magnetic resonance imaging (MRI), can pose a dilemma, delaying or even leading to mistreatment.

Case description: A 19-year-old male presented with acute onset paraparesis and bowel bladder involvement presented with an MRI lumbar spine suggesting leptomeningeal metastasis from D11-L5 levels who underwent decompression biopsy which on histopathological examination revealed to be tubercular granulomatous infection. Anti-tubercular drug (ATD) started, and significant improvement was seen in the lower limb power and tone. The outcome of treatment has been unpredictable. Previous case studies having neurological deficits due to severe compression, including ours, show good recovery after surgical decompression and ATD regime.

Conclusion: Such cases should be managed with high suspicion as they can be easily misdiagnosed to be tumors, leading to mistreatment or delayed treatment.

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结核性蛛网膜炎：一个罕见的罪魁祸首，在一个年轻人的截瘫-一个病例报告和文献复习。

背景：中枢神经系统结核（TB）的患病率约占所有结核病例的1-2%。像本病例这样的非典型病例，在磁共振成像（MRI）中被解释为脑轻脑膜转移，可能会造成困境，延迟甚至导致不当治疗。病例描述：一名19岁男性患者表现为急性麻痹和膀胱受累，腰椎MRI提示从D11-L5水平的轻脑膜转移，经减压活检，组织病理学检查显示为结核性肉芽肿感染。开始使用抗结核药物（ATD），下肢力量和张力明显改善。治疗的结果难以预测。以前的病例研究，包括我们的病例，由于严重压迫导致神经功能障碍，在手术减压和ATD方案后恢复良好。结论：此类病例易误诊为肿瘤，导致误治或延误治疗，应高度警惕。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Surgical neurology international

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