62 year old female with gradual bilateral paralysis

 

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Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Razmin Aslani

 

Case Section

Neuroradiology

 

Patient's Information

Gender : Female
Age : 62

 

Clinical Summary

62-year-old female presented with gradual bilateral paralysis

 

Imaging Findings

sagittal T1w ,T2w ,STIR cervical spine and sagittal T1w and T2w and coronal and axial T1w with and without gadolinium brain MRI show atlanto-axial cystic lesion with peripherally enhancing epidural mass accompanied by cord compression and myelopathy.Djd and multilevel disc dehydration also is present.

 

Differential Diagnosis

infectious process (abscess)(TB- brucellosis ) cystic tumoral lesion

 

Final Diagnosis

Tuberculosis Abscess &Atlantoaxial Spondylodiskitis

 

Discussion (Related Text)

Tubercle bacillus infections are more insidious than pyogenic infections of the spine. As in pyogenic infections, however, the initial symptoms are nonspecific, and early diagnosis is difficult. In the case ofTB, the symptoms may last for months or years before diagnosis. Tuberculous vertebral osteomyelitis remains a significant medical problem in developing countries. The skeleton is the most common extrapulmonary site of involvement, and spinal TB occurs in 50% of cases of skeletal TB. Plain radiographs and cr are usually unrevealing. MRl is the study of choice to detect spinal TB. The bacillus spreads to the vertebral body hematogenously and, like pyogenic organisms, lodges in the anterior and subchondral portions of the vertebral body.s The granulomatous inflammatory response to the bacillus results in a tubercle, which then invades the surrounding soft tissues and forms a tuberculous abscess. As the abscess grows, the periosteum and the longitudinal ligaments of the spine are elevated, and the abscess extends up and down the spine to involve adjacent vertebrae. The thoracolumbar junction is most frequently involved; involvement of the cervical and upper thoracic spine is unusual. Classically, spinal TB initially involves the anterior and inferior portion of the vertebral body .Extension to other vertebral bodies occurs beneath the anterior and posterior longitudinal ligaments and is referred to as subligamentous spread. Involvement of the posterior elements of vertebral bodies is more common in TB than in other forms of infection. Infection of multiple vertebral bodies and posterior elements occurs, with relative sparing of the disk spaces. This complicates the differentiation ofTB from metastatic neoplasm(1) Cross-sectional imaging is required to better assess the extent of involvement and particularly for the presence of an epidural component and cord compression. MRI is the modality of choice for this, with CT with contrast being a distant second.(2)

 

References

1-John R.Haaga , CT and MRI of the whole body , fifth edition 2009 , page 833. 2-Pott disease.Dr Yuranga Weerakkody and Dr Hani Salam et al.read it:http://radiopaedia.org/articles/pott-disease

 

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