1. SPINAL CORD TUBERCULOMA WITH
SIMULTANEOUS TUBERCULAR
SPONDYLODISKITIS AT SAME VERTEBRAL
LEVEL - A CASE REPORT
Dr. H. S. Das, MD.
MATRIX
Guwahati-5, Assam, India

2. Purpose:
 We report a case of spinal cord tuberculoma
with simultaneous occurrence of Tubercular
Spondylodiskitis at the same vertebral level.

3. Method:
 A 41 year old middle-aged man was referred to us for evaluation
of increasing asymmetric weakness of all four limbs with
intermittent mild fever and neck pain.
 MRI of the cervical spine was undertaken on a 0.2-tesla
permanent magnet system. Routine T1 & T2 Weighted Images
(WI) and post contrast T1 WI sequences were obtained in sagittal,
coronal and axial planes.
 Diagnosis was made by analysis of characteristic MR findings,
laboratory data and marked improvement of clinical symptoms in
response to anti tubercular drugs. Follow up MRI was done after
two months

4. Summary of results :
 MRI revealed spondylodiskitis with increased signal on T2WI
involving the C6-C7 disc space. Peridiscal endplate
involvement was also seen .The C6-C7 disc was hypointense
on T1WI.
 Simultaneous cord involvement at the same vertebral level
was noted by focal rounded area of increased signal at the
corresponding level of the cervical cord on T2 WI. The cord
lesion was hypointense on T1WI. Heterogenous rim
enhancement of the cord lesion was noted which was of near
uniform thickness with hypointense core on post contrast
T1WI.
 Associated leptomeningeal enhancement was seen.
 Follow up MR done after two months showed regression of
the disc & cord lesions

5. Summary of conclusions
 Combination of morphological signal intensity pattern of the
involved disc, peridiscal endplates with rim enhancement of the
adjacent cord lesion is characteristic for tubercular involvement.
 MRI coupled with high clinical suspicion in the appropriate
setting plays an important role in establishing prompt diagnosis
and expediting prompt treatment.
 Occurrence of Pott’s spondylodiskitis is not uncommon in our
country. The simultaneous occurrence of a focal rim enhancing
cord lesion at the same level is however rare.
 Very few cases of spondylodiskitis and simultaneous cord
involvement are reported in the literature. Cord involvement in
these cases is however detected at non-corresponding levels. To
our mind, this is the first case reported with disc and cord
involvement at the same cervical vertebral level.