Background
Transverse myelitis (TM) is a rare neurological disease in which the
spinal cord is inflamed. Transverse implies that the inflammation
extends across the entire width of the spinal cord.[1] Pott’s
disease or Pott’s disease is a form of tuberculosis that occurs outside
the lungs whereby disease is seen in the vertebrae[2]
Tuberculosis(TB) is a common disease in Sudan .Neurological consequences
of TB are frequently encountered in our practice of neurology
particularly tuberculosis of the spine(Pott,s
disease). Pott,s disease can lead to lower limbs
weakness due to predilection to involve thoracic vertebrae.Involvement
of spinal cord may take several forms; compression,myelitis and
ischaemic effect as a result of endarteritis obliterans.There are few
case reports of tuberculous myelitis in literature.
During our practice we faced by a considerable number of cases that have
been managed successfully with iv methyl prednisolone therefore we
decided to start reporting such uncommon cases. Literature search we
found some case reports more or less with similarity to our case.A case
report from India :Tuberculous myelitis can occur as a secondary event
in the course of common forms of tuberculous meningitis. It is an
important and not an uncommon cause of paraparesis in Indian
setting.[3,4] Tuberculous myelitis generally occurs when the
diagnosis has been delayed and thick exudates form with spinal blocks.
Occasionally, the infection may begin in the spinal area resulting in
backache and involvement of the spinal cord and roots at multiple
levels. In the early stages, this may be confused with other forms of
viral myeloradiculopathies, but the evidence of elevated CSF protein,
reduction of sugar, largely lymphocytic cellular count and presence of
acid fast bacilli should confirm the diagnosis. PCR for Mycobacterium
tuberculosis of the cerebrospinal fluid is a very specific test in its
diagnosis. The patient should be treated with antituberculous drugs
rifampicin, isoniazid, pyrazinamide, streptomycin and/or ethambutol. Use
of steroids is recommended.[5] Gouri Devi has advocated the use of
intrathecal hyaluronidase, for arachnoiditis[6], but double blind
control studies are needed before this treatment can be routinely
advocated. With the advent of M.R.I. identification of such lesions have
become much more easier.Intramedullary. The most common central nervous
system (CNS) manifestations of TB is tuberculous meningitis (95 %),
followed by cerebral tuberculoma and tuberculous abscess. OThe most
common central nervous system is # 40, CNS, and # 41; the
manifestations of tuberculosis are tuberculous meningitis (95%),
followed by cerebral tuberculoma and tuberculous abscess. Other
infrequent manifestations are cranial tuberculosis, tuberculous
pachymeningitis (Tariq and Ahmed 2012) and spinal arachnoiditis (Naidoo
et al. 1991). Intramedullary spinal tuberculosis is a rare presentation.
Few cases of intramedullary spinal tuberculosis have been reported in
the literature (Lin et al. 1994). Longitudinally Extended Transverse
Myelitis (LETM) is characterized by an immune-mediated contiguous
inflammatory lesion of the spinal cord that extends to three or more
segments of the spinal cord (West 2013).Tuberculosis is a rare cause of
LETM. [5]Find articles by Rajendra Singh Jain
Sunil Kumar
Department of Neurology, Sawai Man Singh Medical College, Jaipur,
Rajasthan India
Find articles by Sunil Kumar
Shankar Tejwani
Department of Radiology, Sawai Man Singh Medical College, Jaipur,
Rajasthan India
Find articles by Shankar Tejwani
Department of Neurology, Sawai Man Singh Medical College, Jaipur,
Rajasthan India
Department of Radiology, Sawai Man Singh Medical College, Jaipur,
Rajasthan India
Rajendra Singh Jain, Phone: +919414073579, Email: moc.oohay@niajsrrd.
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