Open Access, Peer-reviewed
pISSN 2093-4378
eISSN 2093-4386
    J Korean Soc Spine Surg. 2004 Mar;11(1):55-60. Korean.
    Published online Mar 31, 2004.
    https://doi.org/10.4184/jkss.2004.11.1.55
    Copyright © 2004 Korean Society of Spine Surgery
    Case Report

    Epidural Tuberculoma which invades Cauda Equina of Lumbar Spine

    Dong Ki Ahn, M.D., Song Lee, M.D., Ki Woong Jeong, M.D. and Joon Seong Park, M.D.
      • Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Korea.
    • Address reprint requests to Dong Ki Ahn, M.D. Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, 40-12 Chungryangri-dong, Dongdaemoon-gu, Seoul 130-011, Korea. Tel: 82-2-966-1616, Fax: 82-2-968-2394, Email: adkajs@hanmail.net

    Abstract

    Epidural tuberculoma without bony involvement was first reported by Rao et al. in 1971; however, extraosseous spinal epidural tuberculoma and tuberculous infection of the cauda equina have never been reported. We experienced a case of epidural tuberculoma without bony involvement, which was diagnosed by decompression and biopsy, and treated with combined antituberculous chemotherapy. It resembled herniated nucleus pulposus at the L4-5 level, based on its clinical features, a physical examination, myelography and computed tomography. In the course of antituberculous medication, tuberculosis of the cauda equina occurred, which caused paraparesis. Herein, this case is reported in terms of its treatment and clinical course, with a review of the literature.

    Keywords
    Epidural space; Cauda Equina; Tuberculoma

    Figures

    Fig. 1
    (A) Preoperative myelography. Anteroposterior and lateral myelogram showing a complete block of the contrast media at the level of the L4-5 disc due to a space occupying lesion in the epidural space. (B) CT myelography showing a epidural mass, but no destruction of vertebral body, pedicles and transverse processes.

    Fig. 2
    (A) Photomicrograph of biopsy specimen showing typical tuberculous granulation tissue. Typical Langhan-type giant cells(arrow), caseation necrosis(open arrow) are seen (Hematoxylin & Eosin staining, ×100). (B) Acid-fast bacilli(small arrow) in granulomatous tissue, taken from same biopsy specimen are also noted (AFB staining ×400).

    Fig. 3
    T1-weighted MR image which shows indistinguishable cauda equina due to edematous change and epidural collection of fluid, considered as cold abscess.

    Fig. 4
    T2-weighted MR image which shows a nodular, hypointense intradural lesions at L5 body level which surmised as tuberculomas.

    Fig. 5
    T2-weighted MR image which shows remarkably decreased intradural lesions.

    References

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    MeSH Terms
    Biopsy
    Cauda Equina*
    Decompression
    Drug Therapy
    Epidural Space
    Myelography
    Paraparesis
    Physical Examination
    Spine*
    Tuberculoma*
    Tuberculosis
    Metrics
    Share
    Figures
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