Clinical features and MRI findings of tuberculous meningitis associated with syringomyelia

Abstract

Objective To summarize the clinical features and magnetic resonance imaging (MRI) findings of tuberculous meningitis (TBM) associated with syringomyelia. Methods Clinical records, cerebrospinal fluid (CSF) and MRI were analysed retrospectively in 9 patients with concurrent TBM and syringomyelia from May 2006 to May 2010 in Changsha Central Hospital. Results There were 9 patients (6 men and 3 women) with subacute or chronic onset of TBM associated with syringomyelia. The age of onset of these 9 patients were ranged from 16 to 43 years. Six patients had fever and headache or cough at onset who subsequently developed weakness and numbness of the lower extremities and (or) fecal and urinary incontinence 5-110 d later. Three TBM patients developed weakness and numbness of the lower extremities and (or) fecal and urinary incontinence 6 months to 1 year later after the completion of treatment with antituberculous drugs. There was no correspondonce between signs and symptoms. The characteristic segmental dissociated sensory disturbance was not typical. Before antituberculotic treatment, leukocyte count in CSF was moderately increased [(5-420) × 10 6/L], protein level of CSF was increased (2.50-4.16 g/ L), while the level of glucose (1.07-2.15 mmol/L) and chlorine (101-119) mmol/L in CSF decreased. After the treatment with antituberculous drugs, the protein level of CSF in 4 cases was still increased (0.72-1.55 g/L) while others became normal. Longitudinal lesions with different types such as bead-like, sausage-like, spindle-like or slender cavitates were found in the central of spinal cord. The cavitates showed long T1 and long T2 signals as same as signals of CSF and were not enhanced on MRI. At the lesion site subarachnoid space appeared narrowed. Spinal meninges revealed enhancement on enhanced MRI. The cavitates presented multilocular in cervical cord (5 cases), thoracic cord (8 cases), lumbar cord (6 cases), or cervical cord to lumbar cord (4 cases). The severity was not parallel to the diameter as well as the length of the cavitates. Conclusion Syringomyelia can be an early or delayed complication of tuberculous meningitis. The clinical syndromes of tuberculous meningitis associated with syringomyelia may be atypical. The cavitates are mainly found in the thoracic cord and are usually multilocular and multisegmental. The symptomatic severity may not be parallel to neuroimaging changes. Improving the understanding of this disease and performing MRI without delay are helpful for early diagnosis.

DOI：10.3969/j.issn.1672-6731.2011.05.016