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Vengalathur Ganesan Ramesh - One of the best experts on this subject based on the ideXlab platform.
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en plaque intradural extramedullary spinal Tuberculoma and concurrent intracranial Tuberculomas paradoxical response to antituberculous therapy
Journal of Neurosurgery, 2007Co-Authors: Natarajan Muthukumar, Venkatachalam Sureshkumar, Vengalathur Ganesan RameshAbstract:✓Spinal intradural extramedullary Tuberculoma is a rare entity. Rarer still are extensive en plaque intradural extramedullary Tuberculomas occurring concurrently with multiple intracranial Tuberculomas as a paradoxical response to chemotherapy for tuberculosis (TB). The authors describe the case of a 21-year-old man who was treated for tuberculous meningitis. Three months after the episode of meningitis, while undergoing chemotherapy for TB, he developed features of thoracic myelopathy. Investigations revealed an extensive en plaque intradural extramedullary lesion spanning seven segments in the lower thoracic spine. Magnetic resonance imaging of the brain revealed multiple asymptomatic intracranial Tuberculomas. Even after further treatment with antituberculous chemotherapy was initiated, the lesion failed to respond. The authors performed a laminectomy and excised the en plaque intradural extramedullary lesion. The patient’s condition responded well to this treatment. Although the appearance of intracra...
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En plaque intradural extramedullary spinal Tuberculoma and concurrent intracranial Tuberculomas: paradoxical response to antituberculous therapy. Case report.
Journal of neurosurgery. Spine, 2007Co-Authors: Natarajan Muthukumar, Venkatachalam Sureshkumar, Vengalathur Ganesan RameshAbstract:Spinal intradural extramedullary Tuberculoma is a rare entity. Rarer still are extensive en plaque intradural extramedullary Tuberculomas occurring concurrently with multiple intracranial Tuberculomas as a paradoxical response to chemotherapy for tuberculosis (TB). The authors describe the case of a 21-year-old man who was treated for tuberculous meningitis. Three months after the episode of meningitis, while undergoing chemotherapy for TB, he developed features of thoracic myelopathy. Investigations revealed an extensive en plaque intradural extramedullary lesion spanning seven segments in the lower thoracic spine. Magnetic resonance imaging of the brain revealed multiple asymptomatic intracranial Tuberculomas. Even after further treatment with antituberculous chemotherapy was initiated, the lesion failed to respond. The authors performed a laminectomy and excised the en plaque intradural extramedullary lesion. The patient's condition responded well to this treatment. Although the appearance of intracranial Tuberculoma as a paradoxical response to chemotherapy has been previously reported, no authors have reported on the development of an extensive en plaque intradural extramedullary Tuberculoma in conjunction with asymptomatic multiple intracranial Tuberculomas as a paradoxical response. In cases in which patients present with compressive myelopathy following therapy for tuberculous meningitis, it is important to consider in the differential diagnosis that intradural extramedullary Tuberculoma may be a paradoxical response to chemotherapy. The authors' experience and their review of the literature indicate that surgery has a definitive role to play in the management of spinal intradural extramedullary Tuberculoma.
Natarajan Muthukumar - One of the best experts on this subject based on the ideXlab platform.
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en plaque intradural extramedullary spinal Tuberculoma and concurrent intracranial Tuberculomas paradoxical response to antituberculous therapy
Journal of Neurosurgery, 2007Co-Authors: Natarajan Muthukumar, Venkatachalam Sureshkumar, Vengalathur Ganesan RameshAbstract:✓Spinal intradural extramedullary Tuberculoma is a rare entity. Rarer still are extensive en plaque intradural extramedullary Tuberculomas occurring concurrently with multiple intracranial Tuberculomas as a paradoxical response to chemotherapy for tuberculosis (TB). The authors describe the case of a 21-year-old man who was treated for tuberculous meningitis. Three months after the episode of meningitis, while undergoing chemotherapy for TB, he developed features of thoracic myelopathy. Investigations revealed an extensive en plaque intradural extramedullary lesion spanning seven segments in the lower thoracic spine. Magnetic resonance imaging of the brain revealed multiple asymptomatic intracranial Tuberculomas. Even after further treatment with antituberculous chemotherapy was initiated, the lesion failed to respond. The authors performed a laminectomy and excised the en plaque intradural extramedullary lesion. The patient’s condition responded well to this treatment. Although the appearance of intracra...
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En plaque intradural extramedullary spinal Tuberculoma and concurrent intracranial Tuberculomas: paradoxical response to antituberculous therapy. Case report.
Journal of neurosurgery. Spine, 2007Co-Authors: Natarajan Muthukumar, Venkatachalam Sureshkumar, Vengalathur Ganesan RameshAbstract:Spinal intradural extramedullary Tuberculoma is a rare entity. Rarer still are extensive en plaque intradural extramedullary Tuberculomas occurring concurrently with multiple intracranial Tuberculomas as a paradoxical response to chemotherapy for tuberculosis (TB). The authors describe the case of a 21-year-old man who was treated for tuberculous meningitis. Three months after the episode of meningitis, while undergoing chemotherapy for TB, he developed features of thoracic myelopathy. Investigations revealed an extensive en plaque intradural extramedullary lesion spanning seven segments in the lower thoracic spine. Magnetic resonance imaging of the brain revealed multiple asymptomatic intracranial Tuberculomas. Even after further treatment with antituberculous chemotherapy was initiated, the lesion failed to respond. The authors performed a laminectomy and excised the en plaque intradural extramedullary lesion. The patient's condition responded well to this treatment. Although the appearance of intracranial Tuberculoma as a paradoxical response to chemotherapy has been previously reported, no authors have reported on the development of an extensive en plaque intradural extramedullary Tuberculoma in conjunction with asymptomatic multiple intracranial Tuberculomas as a paradoxical response. In cases in which patients present with compressive myelopathy following therapy for tuberculous meningitis, it is important to consider in the differential diagnosis that intradural extramedullary Tuberculoma may be a paradoxical response to chemotherapy. The authors' experience and their review of the literature indicate that surgery has a definitive role to play in the management of spinal intradural extramedullary Tuberculoma.
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surgery for intramedullary Tuberculoma of the spinal cord report of 2 cases
Surgical Neurology, 2006Co-Authors: Natarajan Muthukumar, Govindaraju Venkatesh, Suyambu Senthilbabu, Rajamariappan RajbaskarAbstract:Abstract Background Intramedullary Tuberculomas are rare. With the widespread availability of MRI and the increasing incidence of HIV and HIV-related tuberculous infections, the incidence of these lesions is likely to increase worldwide. The role of medical and surgical treatment of these relatively rare lesions remains to be defined. We report 2 patients who presented with intramedullary Tuberculomas and discuss the importance of early surgery in this condition. Case Description Two female patients presented with insidious onset of myelopathy. The first patient had seizures due to imaging-documented intracranial Tuberculomata and progressive paraparesis due to an intramedullary Tuberculoma. The second patient had also had insidious onset of myelopathy and evidence of an intramedullary Tuberculoma in MRI. She was also found to have abdominal and pulmonary tuberculosis. In view of the presence of tuberculosis elsewhere in the body in both the patients and the classical imaging features of intramedullary Tuberculoma, they were treated initially with antituberculous chemotherapy. However, despite chemotherapy, both patients did not show improvement. Subsequently, both patients underwent microsurgical removal of the intramedullary lesions. The first patient who was neurologically well preserved at the time of surgery improved, whereas the second patient who was paraplegic with sphincter disturbances did not show any improvement. Conclusions These case reports are presented to highlight the role of early surgery in patients with profound neurological deficits and intramedullary Tuberculoma even if the radiological appearance of the lesion is characteristic. Even in lesions that are potentially curable by chemotherapy, early surgery has an important role in the treatment.
İsmail Hakkı Aydin - One of the best experts on this subject based on the ideXlab platform.
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Intramedullary spinal Tuberculoma: a case report.
Spine, 2000Co-Authors: Ç. R. Kayaoğlu, Yusuf Tuzun, Zeki Boga, Fazli Erdogan, Metin Gorguner, İsmail Hakkı AydinAbstract:Study Design. A case report showing an intramedullary thoracic spinal tubercuioma secondary to pulmonary tuberculosis in a 16-year-old patient with findings of subacute spinal cord compression. Objectives. The significance and the use of magnetic resonance imaging in the diagnosis of intramedullary Tuberculoma, and the treatment of the patient that involves surgically the excision of intramedullary lesion followed by appropriate antituberculous therapy. Summary of Background Data. Tuberculomas of spinal cord are rare entities. The possibility of intramedullary Tuberculoma should be seriously considered when an intraspinal mass is found, provided that pulmonary tuberculosis is present in the history of the patient. Method. Th4-Th5 laminectomy was performed. Intramedullary Tuberculoma was excised through a myelotomy. Antituberculous treatment was applied after the surgery. Results. Excellent clinical outcome was obtained with a combination of both medical and surgical treatments. Conclusion. The intramedullary spinal Tuberculoma, although a rare entity, must be considered in the differential diagnosis of the spinal cord compression in patients with a history of tuberculosis, human immunodeficiency virus, and those who have a bad socioeconomic condition and bad nutrition habit. When confronted with a progressing neurologic deficit, a combination of microsurgical resection and antituberculous chemotherapy with the avoidance of steroids should be the choice of treatment for intramedullary Tuberculomas.
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Optochiasmatic Tuberculoma--case report and review.
Zentralblatt fur Neurochirurgie, 1996Co-Authors: Gundogdu C, Yusuf Tuzun, Deniz O, Erhan Takçi, İsmail Hakkı AydinAbstract:An optochiasmatic Tuberculoma, encasing the chiasm and optic nerves, was found in a 58-year-old woman complaining of sudden beginning and progressive visual failure. The patient was treated by surgery and prolonged corticosteroids and continued triple antituberculous therapy. Pathological diagnosis was a Tuberculoma confirmed by postoperative positive polymerase chain reaction against M. tuberculosis. Because the incidence of Tuberculomas has increased, especially in developing countries, in recent years and they also involve optic nerves and chiasm, it is important to include optochiasmatic Tuberculoma in the differential diagnosis of optic nerve and chiasm tumors. Including this case, only 31 instances of optochiasmatic Tuberculoma have been reported in the literature.
Yimin Fang - One of the best experts on this subject based on the ideXlab platform.
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Intracisternal Tuberculoma: a refractory type of Tuberculoma indicating surgical intervention
BMC neurology, 2018Co-Authors: Fanfan Chen, Lei Chen, Yongfu Cao, Jingwen Zhuang, Wei Xie, Yimin FangAbstract:Central nervous system (CNS) Tuberculoma is a rare disease with severe neurological deficits. This retrospective research is to review the data of patients diagnosed as CNS Tuberculoma. Surgeries were performed in all patients. The clinical features especially the neurological image and the anatomical characters of the Tuberculomas were concerned. Totally 11 patients diagnosed as CNS Tuberculoma were admitted in Guangzhou First People’s Hospital (7cases) and Changzheng Hospital (4 cases) during 2006–2015. The data including preoperative condition, neurological imaging, and surgical findings was collected and analyzed. The lesions of nine patients (9/11) were totally or subtotally excised and two (2/11) were partially excised. Neurological functions of all patients were improved after surgery without secondary infection. Lesions of nine (9/11) patients preoperatively progressed as a result of paradoxical reaction. Of the 9 patients demonstrated paradoxical progression, all lesions were partially or totally located at the cisterns or the subarachnoid space. Preoperative ATTs lasted 2 to 12 months and Tuberculomas were not eliminated. The arachnoid was found thickened and tightly adhered to the lesions during surgeries. Of the 2 cases that paradoxical reaction were excluded, both patients (case 6, intramedullary Tuberculoma; case 11, intradural extramedullary Tuberculoma) were admitted at onset of the disease. ATTs were preoperatively given for 1 week as neurological deficits aggravated. The tuberculous lesions of CNS or other system showed no obvious change and paradoxical reaction could not be established in both cases. Exudates of tuberculosis is usually accumulated in the cisterns and frequently results in the paradoxical formation of Tuberculoma. Intracisternal Tuberculoma is closely related to paradoxical reaction and refractory to anti-tuberculosis therapy. Micro-surgical excision is safe and effective. Early surgical intervention may be considered in the diagnosis of intracisternal Tuberculoma especially when paradoxical reaction participates in the development of Tuberculoma.
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Intracisternal Tuberculoma: a refractory type of Tuberculoma indicating surgical intervention
BMC, 2018Co-Authors: Fanfan Chen, Lei Chen, Yongfu Cao, Jingwen Zhuang, Wei Xie, Yimin FangAbstract:Abstract Background Central nervous system (CNS) Tuberculoma is a rare disease with severe neurological deficits. This retrospective research is to review the data of patients diagnosed as CNS Tuberculoma. Surgeries were performed in all patients. The clinical features especially the neurological image and the anatomical characters of the Tuberculomas were concerned. Methods Totally 11 patients diagnosed as CNS Tuberculoma were admitted in Guangzhou First People’s Hospital (7cases) and Changzheng Hospital (4 cases) during 2006–2015. The data including preoperative condition, neurological imaging, and surgical findings was collected and analyzed. Results The lesions of nine patients (9/11) were totally or subtotally excised and two (2/11) were partially excised. Neurological functions of all patients were improved after surgery without secondary infection. Lesions of nine (9/11) patients preoperatively progressed as a result of paradoxical reaction. Of the 9 patients demonstrated paradoxical progression, all lesions were partially or totally located at the cisterns or the subarachnoid space. Preoperative ATTs lasted 2 to 12 months and Tuberculomas were not eliminated. The arachnoid was found thickened and tightly adhered to the lesions during surgeries. Of the 2 cases that paradoxical reaction were excluded, both patients (case 6, intramedullary Tuberculoma; case 11, intradural extramedullary Tuberculoma) were admitted at onset of the disease. ATTs were preoperatively given for 1 week as neurological deficits aggravated. The tuberculous lesions of CNS or other system showed no obvious change and paradoxical reaction could not be established in both cases. Conclusions Exudates of tuberculosis is usually accumulated in the cisterns and frequently results in the paradoxical formation of Tuberculoma. Intracisternal Tuberculoma is closely related to paradoxical reaction and refractory to anti-tuberculosis therapy. Micro-surgical excision is safe and effective. Early surgical intervention may be considered in the diagnosis of intracisternal Tuberculoma especially when paradoxical reaction participates in the development of Tuberculoma
Seog Hee Park - One of the best experts on this subject based on the ideXlab platform.
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mr imaging of solitary pulmonary lesion emphasis on Tuberculomas and comparison with tumors
Journal of Magnetic Resonance Imaging, 2000Co-Authors: Myung Hee Chung, Hae Giu Lee, Soon Suck Kwon, Seog Hee ParkAbstract:The aim of this study was to determine whether solitary pulmonary Tuberculoma and malignant tumor can be differentiated on the basis of magnetic resonance (MR) signal intensity. Twenty-eight patients with solitary pulmonary lesions were prospectively studied with MR imaging: T1-weighted, enhanced T1-weighted, proton density-weighted, and T2-weighted spin echo images were obtained. The confirmation methods used were computed tomography (CT)-guided biopsy in seven patients with lung cancer and four patients with tuberculosis; surgery in ten patients with lung cancer and five patients with tuberculosis; and laboratory data in two patients with tuberculosis. Morphologic features and MR signal intensity were examined in detail. As the test for detection of Tuberculoma, signal difference on T2-weighted images was carefully analyzed. The signal intensity ratio of the nodule to thoracic muscle signal intensity was measured. The signal intensities obtained from the lung cancers and Tuberculomas were variable on pre-and post-enhanced T1-weighted images and proton density-weighted images. Masses were hypointense in 2 of 17 patients with lung cancer and in 9 of 11 patients with Tuberculoma on T2-weighted images (sensitivity 82%, specificity 89%, accuracy 87%). The mean signal intensity ratios of the Tuberculomas to muscle were significantly lower than those of malignant tumors on T1-weighted, enhanced T1-weighted, proton density-weighted, and T2-weighted images (P < 0.0001). After gadolinium-DTPA enhancement, 2 malignant tumors and 7 Tuberculomas showed a marginal rim enhancement pattern, whereas 15 malignant tumors and 2 Tuberculomas revealed a diffuse enhancement. The results of MR imaging were consistent with those of CT in 84% of the patients. MR imaging is a helpful adjunctive method in terms of differentiating a Tuberculoma from a malignant tumor. J. Magn. Reson. Imaging 2000;11:629–637. © 2000 Wiley-Liss, Inc.
