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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