PMC8720442_01
(a) T2W sagittal image showing a hyperintense intramedullary lesion from T6 to T9. (b) T2W axial image showing the same hyperintense lesion.
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F1
A magnetic resonance imaging (MRI) from an outside clinic showed a hyperintense intramedullary lesion, on T2W imaging, from T6 to T9 [Figure 1].
(a) T1W sagittal images with contrast showing fusiform dilation of the spinal cord from T6 to T9 with no enhancement. (b) T1W axial image showing the same finding.
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F2
A similar finding was present on the axial cuts [Figure 2].
(a) Low-power view (x20) of thickened and hyalinized connective tissue (meninges) strips with infiltration by large nodular foci of dense inflammation. The slide was stained with hematoxylin and eosin. (b) A closer view (x200) revealed coalescing loose epithelioid cell granulomas and scattered Langhan's multinucleated giant cells on a background of lymphocytes and plasma cells. The slide was stained with hematoxylin and eosin.
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F3
Histopathological examination of the lesion showed features suggestive of tuberculous granulomatous inflammation [Figure 3].
(a) T2W sagittal image taken at the 8-month review with the patient on antitubercular treatment. There is a complete resolution of the lesion. There are chronic arachnoid adhesions present at the T3 level. (b) T2W axial image showing complete resolution of the lesion.
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F4
The review scans [Figure 4] showed complete resolution of the lower lesion but now showed evidence of chronic arachnoid adhesions at the T3 level.
Computed tomography brain taken at the 8-month review showing features suggestive of noncommunicating hydrocephalus. There is dilation of the fourth ventricle, aqueduct, third ventricle, and bilateral lateral ventricles with transependymal cerebrospinal fluid seepage. There is no dilation of the foramina of Luschka or Magendie. We believe that this was caused as a result of tubercular meningitis or arachnoiditis.
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F5
A CT brain performed at the same time showed evidence of hydrocephalus, most likely noncommunicating in nature [Figure 5].