Intraspinal tuberculoma
Introduction
Introduction to intraductal tuberculoma Intraspinal tuberculoma is a tuberculous granuloma that invades the spinal cord within the spinal canal or epidural. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific population Mode of infection: non-infectious Complications:
Cause
Causes of intraductal tuberculosis
Secondary disease (95%):
Intraspinal tuberculoma is a tuberculosis lesion secondary to other parts of the body. The majority of tuberculosis is spread by the blood vessels of other parts of the body through the bloodstream into the spinal canal. The lesions of tuberculous meningitis can also be directly spread. spinal cord.
Pathogenesis
Intraspinal tuberculoma can occur in any segment of the spinal cord, either intramedullary or extradural, or epidural, with relatively common lesions in the spinal cord.
The epidural tuberculosis lesions are often ring-shaped, and it is difficult to separate from the dura mater. The dura mater can be 3 to 5 mm thick, and the ring is contracted to compress the spinal cord. The lesion texture is often hard, and the ring-shaped contraction is more. The spinal cord is not directly invaded, and the dural decompression can be performed longitudinally during surgery.
The epidural extramedullary tuberculosis ball is the most common type, mostly hard round, oval or irregular mass, generally less than 3cm in diameter, dark yellow, often close to the dura mater, soft membrane and spinal cord. Sticky.
The tuberculosis in the spinal cord has clear borders, hard and grayish white, varying in size, and often between 7 and 10 mm in diameter.
Histological examination showed that the center of the tuberculosis ball was a caseous necrotic area surrounded by granulation tissue, which showed Langhans giant cells and epithelial cells.
Prevention
Intraspinal tuberculosis prevention
For susceptible populations, vaccination against tuberculosis should be used to prevent the formation of tuberculomas in the spinal canal.
Complication
Intraspinal tuberculoma complications Complications
Symptoms of spinal cord compression are paralyzed and numb in the plane below the lesion.
Symptom
Symptoms of intraductal tuberculosis common symptoms ESR increased fast back pain limb or trunk numb cerebrospinal fluid white blood cells increased spinal cord nerve root stimulation defecation disorder
More common in children or young people, the incidence of gender is not significantly different, the course of disease development is faster, but relatively slower than suppurative epidural abscess, usually 6 months, rarely more than 1 year, more than 80% of patients have Tuberculosis or other history of tuberculosis outside the lungs, the compression of the spinal cord is often a subacute or chronic process, epidural tuberculosis often has back pain or nerve root irritation, spinal tuberculosis balls rarely cause pain symptoms, spinal cord compression symptoms It is common to have paralysis, numbness, and dysfunction of the lower limbs below the lesion.
Examine
Examination of intraductal tuberculomas
The protein content of cerebrospinal fluid increased, the number of cells was normal or slightly increased, the chloride decreased or normal, the erythrocyte sedimentation rate accelerated, and the kinetic test showed complete obstruction.
The X-ray film of the spine was normal, and the iodine angiography showed complete obstruction. The M1 T1W1 was slightly higher signal and the T2 W1 was slightly lower.
Diagnosis
Diagnosis and diagnosis of intraductal tuberculoma
The clinical manifestations of intraductal tuberculomas are diversified, and the symptoms are not easy to distinguish from other intraspinal space-occupying lesions, such as spinal canal occupying symptoms in children or young people. In the past, there were tuberculosis history or other parts of tuberculosis. ESR increases, white blood cells in the cerebrospinal fluid increase, chloride decreases, that is, the possibility of intraductal tuberculosis should be highly suspected. MRI examination is helpful for definite diagnosis.
Need to distinguish from other intraspinal space-occupying lesions, such as epidural abscess, epidural hematoma and intraspinal tumors, can be combined with medical history and imaging findings to make a diagnosis.
