J Korean Soc Spine Surg.  2004 Mar;11(1):55-60. 10.4184/jkss.2004.11.1.55.

Epidural Tuberculoma which invades Cauda Equina of Lumbar Spine

• Ahn DK
• Lee S
• Jeong KW
• Park JS

• KMID: 2003192
• DOI: http://doi.org/10.4184/jkss.2004.11.1.55

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.

Keyword

Epidural space; Cauda Equina; Tuberculoma

MeSH Terms

Biopsy
Cauda Equina*
Decompression
Drug Therapy
Epidural Space
Myelography
Paraparesis
Physical Examination
Spine*
Tuberculoma*
Tuberculosis

Figure

• 

  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.

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  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).

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

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

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

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