Neurology India
menu-bar5 Open access journal indexed with Index Medicus
  Users online: 2182  
 Home | Login 
About Editorial board Articlesmenu-bullet NSI Publicationsmenu-bullet Search Instructions Online Submission Subscribe Videos Etcetera Contact
  Navigate Here 
  » Next article
  » Previous article 
  » Table of Contents
 Resource Links
  »  Similar in PUBMED
 »  Search Pubmed for
 »  Search in Google Scholar for
 »Related articles
  »  Article in PDF (145 KB)
  »  Citation Manager
  »  Access Statistics
  »  Reader Comments
  »  Email Alert *
  »  Add to My List *
* Registration required (free)  

  In this Article
 »  Abstract
 »  Introduction
 »  Case Report
 »  Discussion
 »  References
 »  Article Figures

 Article Access Statistics
    PDF Downloaded306    
    Comments [Add]    
    Cited by others 17    

Recommend this journal


Year : 2009  |  Volume : 57  |  Issue : 2  |  Page : 211-212

Intradural extramedullary tuberculoma mimicking en plaque meningioma

Department of Neurosurgery, Ministry of Health Okmeydani Education and Research Hospital, Istanbul, Turkey

Date of Acceptance31-Mar-2009

Correspondence Address:
Erdinc Ozek
Neurosurgery Clinic, Ministry of Health Okmeydani Education and Research Hospital, Istanbul
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.51300

Rights and Permissions

 » Abstract 

In this paper we report an 18 year old woman with an intradural extramedullary tuberculoma mimicking en plaque meningioma located in the thoracic region. The patient was operated via thoracic laminoplasty and tumor was totally resected. On the follow-up examination the magnetic resonance imaging demonstrated the total excision of the tumor. Here we describe a case of intradural extramedullary tuberculoma of the spinal cord as a complication of tuberculosis meningitis in a previously healthy young female.

Keywords: Extramedullary, intradural, tuberculoma

How to cite this article:
Ozek E, Iplkcioglu A C, Erdal M. Intradural extramedullary tuberculoma mimicking en plaque meningioma. Neurol India 2009;57:211-2

How to cite this URL:
Ozek E, Iplkcioglu A C, Erdal M. Intradural extramedullary tuberculoma mimicking en plaque meningioma. Neurol India [serial online] 2009 [cited 2023 Dec 11];57:211-2. Available from:

 » Introduction Top

Intradural extramedullary tuberculoma of the spinal cord is a rare modality of tuberculosis and it is usually associated with tuberculosis meningitis. The pathogenesis is unclear, although a paradoxical reaction to antituberculosis medication is a reasonable possibility.

 » Case Report Top

A 18-year-old woman was admitted to our clinic with refractory dorsal pain and generalized weakness of both the lower extremities. She had a history of tuberculous meningitis of six months duration and was on antituberculous therapy. Her neurological examination revealed spastic weakness of both the lower extremities (grade 3/5) with exaggerated reflexes and bilaterally upgoing plantars. She also exhibited hypoesthesia below the T1 level. Magenetic resonance imaging (MRI) of the spinal cord showed an intradural extramedullary en plaque-shaped mass, extending from T1-9 vertebral column [Figure 1]. We performed a T1-9 laminoplasty and microscopic total removal of intradural extramedullary tuberculoma. Light microscopy of the lesion revealed granulomas with multinucleated and Langhans-type giant cells, confirming the diagnosis of the intradural extramedullary tuberculoma [Figure 2]. Postoperatively she had improvement in the motor strength of the bilateral lower extremities (grade 4/5). When reviewed at six months after the surgery, repeat MRI of the spinal cord confirmed the total resection [Figure 3]. She was continued on anti-tuberculous up to a year.

 » Discussion Top

Dastur reviewed 74 cases of spinal tuberculomas and the lesion location was: Extradural in 64%, arachnoidal in 20%, intramedullary in 8%, and intadural extramedullary in 8%. [1] Intradural extramedullary tuberculoma is usually associated with tuberculous meningitis. An increase in the size of tuberculomas in patients undergoing antituberculosis treatment is believed to be due to paradoxical response. [2] The paradoxical response to antituberculosis chemotherapy is thought to be due to the result of an immunological reaction. [2] Continuation of antituberculosis chemotherapy is usually sufficient when the paradoxical reaction develops in intracranial tuberculoma; however, in spinal tuberculomas prompt surgery may be indicated. [2] Like in our case, en plaque intradural extramedullary tuberculomas are very rare lesions and only two cases reported in the literature so far. [2],[3] Because of the similar radiologic findings, intradural extramedullary tuberculomas should be considered in the differential diagnosis of the spinal meningioma and schwannoma. [2] The case has been reported owing to the rarity of intradural extramedullary tuberculoma of the spinal cord as a complication of tuberculosis meningitis in a previously healthy young female.

 » References Top

1.Dastur HM. Diagnosis and neurosurgical treatment of Tuberculosis disease of the CNS. Neurosurg Rev 1983;6:111-7.  Back to cited text no. 1  [PUBMED]  
2.Muthukumar N, Sureshkumar V, Ramesh VG. En plaque intradural extramedullary spinal tuberculoma and concurrent intracranial tuberculomas: Paradoxical response to antituberculosis therapy. Case report. J Neurosurg Spine 2007;6:169-73.  Back to cited text no. 2    
3.Mirzai H. Tuberculoma of the Cervical Spinal Canal Mimicking En Plaque Meningioma. J Spinal Disord Tech 2005;18:197-9.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]


  [Figure 1], [Figure 2], [Figure 3]

This article has been cited by
1 A Case of Partial Resection of an Intradural Extramedullary Tuberculoma Resulting in Improvement of Lower Limb Paralysis
Atsushi Yunde, Satoshi Maki, Takeo Furuya, Jun-ichiro Ikeda, Seiji Ohtori
Cureus. 2023;
[Pubmed] | [DOI]
2 Intradural extramedullary tuberculoma masquerading en plaque meningioma
Manchikanti Venkatesh, Pentyala Suneetha, VeldurtiAnanta Kiran Kumar, Vissa Santhi, LuisRafael Moscote-Salazar, Amit Agrawal
Asian Journal of Neurosurgery. 2018; 13(3): 928
[Pubmed] | [DOI]
3 Spinal Intramedullary Tuberculosis with Concurrent Supra- and Infratentorial Intracranial Disease in a 9-Month-Old Boy: Case Report and Comprehensive Review of the Literature
Michael George Zaki Ghali,Visish M. Srinivasan,Marc J. Kim,Archana Malik
World Neurosurgery. 2017; 106: 37
[Pubmed] | [DOI]
4 Spinal cord involvement in tuberculous meningitis
R K Garg,H S Malhotra,R Gupta
Spinal Cord. 2015; 53(9): 649
[Pubmed] | [DOI]
5 Intradural Extramedullary Tuberculoma of the Spinal Cord Following Tuberculous Meningitis
Deok-Ki Jeong,Young-Min Kwon
Korean Journal of Spine. 2015; 12(2): 107
[Pubmed] | [DOI]
6 Paradoxical reaction in HIV negative tuberculous meningitis
Ravindra Kumar Garg,Hardeep Singh Malhotra,Neeraj Kumar
Journal of the Neurological Sciences. 2014; 340(1-2): 26
[Pubmed] | [DOI]
7 Presentation of cauda equina syndrome due to an intradural extramedullary abscess: a case report
Nitin Agarwal,Janki Shah,David R. Hansberry,Antonios Mammis,Leroy R. Sharer,Ira M. Goldstein
The Spine Journal. 2014; 14(2): e1
[Pubmed] | [DOI]
8 Tuberculous Pachymeningitis in a Young Child With Spinal Involvement: A Case Report
Abdollah Karimi,Sedigheh Rafiei Tabatabaei,Farideh Shiva,Maryam Sayfikar,Mohsen Jafari,Fariba Shirvani,Reza Shiari
Archives of Pediatric Infectious Diseases. 2013; 1(1): 36
[Pubmed] | [DOI]
9 Infections of the Spinal Subdural Space in Children: A Series of 11 Contemporary Cases and Review of all Published Reports. A Multinational Collaborative Effort
Sandler, A.L. and Thompson, D. and Goodrich, J.T. and Van Aalst, J. and Kolatch, E. and El Khashab, M. and Nejat, F. and Cornips, E. and Mohindra, S. and Gupta, R. and Yassari, R. and Daniels III, L.B. and Biswas, A. and Abbott, R.
Childæs Nervous System. 2013; 29(1): 105-117
10 Abscess of cauda equina presenting as lumboischialgic pain: A case report
Velnar, T. and Bunc, G.
Folia Neuropathologica. 2012; 50(3): 287-292
11 Clinical features and MRI diagnosis of intradural extramedullary tuberculomas in children
Qin, Y. and Cai, J.-H. and Lan, X.-F.
Chinese Journal of Medical Imaging Technology. 2011; 27(7): 1366-1369
12 Long-term Sequela of Intradural Extramedullary Tuberculoma in the Thoracic Dorsal Spinal Cord: Case Report and Review of the Literature
Seil Sohn,Yong Jun Jin,Ki-Jeong Kim,Hyun-Jib Kim
Korean Journal of Spine. 2011; 8(4): 295
[Pubmed] | [DOI]
13 Nontumor lesions of spinal cord and spine
Tatke, M.
Seminars in Diagnostic Pathology. 2010; 27(3): 186-196
14 Infectious lesions mimicking central nervous system neoplasms
Santosh, V. and Mahadevan, A. and T. Chickabasaviah, Y. and Bharath, R.D. and S. Krishna, S.
Seminars in Diagnostic Pathology. 2010; 27(2): 122-135
15 Coexistence between meningioma and tuberculosis: case report
Martha Tena-Suck, Miguel Ángel Collado-Ortiz, Daniel Rembao-Bojórquez, Noemí Gestista, Arturo García-Marquez
Journal of Neuro-Oncology. 2010; 99(2): 289
[VIEW] | [DOI]
16 Infectious lesions mimicking central nervous system neoplasms
Vani Santosh,Anita Mahadevan,Yasha T. Chickabasaviah,Rose Dawn Bharath,Shankar S. Krishna
Seminars in Diagnostic Pathology. 2010; 27(2): 122
[Pubmed] | [DOI]
17 Nontumor lesions of spinal cord and spine
Medha Tatke
Seminars in Diagnostic Pathology. 2010; 27(3): 186
[Pubmed] | [DOI]


Print this article  Email this article
Previous article Next article
Online since 20th March '04
Published by Wolters Kluwer - Medknow