Images in Radiology - Intramedullary Tuberculoma of the Spinal Cord

A 36-year-old man presented with the complaints of intermittent fever and paroxysms of dyspnoea. His chest X-ray film revealed apical changes of the right lung and diffuse interstitial infiltration. The condition was diagnosed as pulmonary tuberculosis and a course of quadruple chemotherapy was begun. Three months after discharge, the patient was referred to the neurosurgery clinic with the complaints of lower back pain, bilateral leg pain and weakness. Neurological examination revealed paraplegia, urinary incontinence and spastic reflexes. Thoracic, cervical and lumbar X-rays were normal. Thoracic spinal magnetic resonance imaging (MRI) revealed a circumscribed intramedullary mass at the level of tenth thoracic vertebrae with a hyperintense ring enhancement of the pia-arachnoid involving the whole of the dorsal cord (Figures 1 and 2). The lesion was diagnosed as intramedullary mass and high-dose steroids were consequently added to the anti-tuberculosis therapy. Cerebral computed tomography was normal.