Diagnosis and Treatment of Cauda Equina Arachnoiditis, a Rare Manifestation of Tuberculosis Meningoencephalitis: A Case Report
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Tuberculous meningoencephalitis (TM) is an acute, progressive form of tuberculosis (TB). The epidemiology, clinical signs, and diagnosis of TB are well established, but several atypical forms of tuberculous spinal arachnoiditis can be easily misdiagnosed. We report a rare case of TM with cauda equina arachnoiditis diagnosed by magnetic resonance imaging and an electrodiagnostic study. A 26-year-old otherwise healthy male patient experienced fever, headache, gait disturbance, and bladder and bowel incontinence. Needle electromyography (EMG) recordings were suggestive of bilateral diffuse lumbar and lumbosacral polyradiculopathy, and the pudendal sensory-evoked potential and bulbocavernosus reflex latencies were prolonged. Lumbar arachnoiditis is a rare clinical condition that warrants a heightened index of suspicion. It has diverse etiologies and symptoms, and it can lead to potentially serious and irreversible disorders. This case illustrates the usefulness of nerve conduction, EMG, and pudendal sensory-evoked potential and bulbocavernosus reflex latency studies in the diagnosis of cauda equina syndrome induced by TB arachnoiditis.
Abstract
Tuberculous meningoencephalitis (TM) is an acute, progressive form of tuberculosis (TB). The epidemiology, clinical signs, and diagnosis of TB are well established, but several atypical forms of tuberculous spinal arachnoiditis can be easily misdiagnosed. We report a rare case of TM with cauda equina arachnoiditis diagnosed by magnetic resonance imaging and an electrodiagnostic study. A 26-year-old otherwise healthy male patient experienced fever, headache, gait disturbance, and bladder and bowel incontinence. Needle electromyography (EMG) recordings were suggestive of bilateral diffuse lumbar and lumbosacral polyradiculopathy, and the pudendal sensory-evoked potential and bulbocavernosus reflex latencies were prolonged. Lumbar arachnoiditis is a rare clinical condition that warrants a heightened index of suspicion. It has diverse etiologies and symptoms, and it can lead to potentially serious and irreversible disorders. This case illustrates the usefulness of nerve conduction, EMG, and pudendal sensory-evoked potential and bulbocavernosus reflex latency studies in the diagnosis of cauda equina syndrome induced by TB arachnoiditis.
참고문헌 (12)
- Sánchez YP, "Tuberculosis meningitis, still misunderstood", J Neuroinfect Dis (2015)
- Thwaites GE, "Tuberculous meningitis: more questions, still too few answers", Lancet Neurol, 12, pp.999~1010 (2013)
- World Health Organization, "Guidelines for treatment of drug-susceptible tuberculosis and patient care, 2017 update", WHO, ~ (2017)
- Killeen T, "Severe adhesive arachnoiditis resulting in progressive paraplegia following obstetric spinal anaesthesia : a case report and review", Anaesthesia, 67, pp.1386~1394 (2012)
- Wright MH, "A comprehensive review of spinal arachnoiditis", Orthop Nurs, 22, pp.215~219 (2003)
- Anderson TL, "Imaging appearance of advanced chronic adhesive arachnoiditis : a retrospective review", AJR Am J Roentgenol, 209, pp.648~655 (2017)
- Hernández-Albújar S, "Tuberculous radiculomyelitis complicating tuberculous meningitis : case report and review", Clin Infect Dis, 30, pp.915~921 (2000)
- Mooij JJ, "Spinal arachnoiditis : disease or coincidence?", Acta Neurochir(Wien), 53, pp.151~160 (1980)
- Rice I, "Obstetric epidurals and chronic adhesive arachnoiditis", Br J Anaesth, 92, pp.109~120 (2004)
- Anderson NE, "Neurological and systemic complications of tuberculous meningitis and its treatment at Auckland City Hospital, New Zealand", J Clin Neurosci, 17, pp.1114~1118 (2010)
- Moghtaderi A, "Tuberculous radiculomyelitis: review and presentation of five patients", Int J Tuberc Lung Dis, 7, pp.1186~1190 (2003)
- Niu X, "Bulbocavernosus reflex and pudendal nerve somatosensory evoked potential are valuable for the diagnosis of cauda equina syndrome in male patients", Int J Clin Exp Med, 8, pp.1162~1167 (2015)