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Tuberculous meningitis with dementia as the presenting symptom after intramedullary spinal cord tumor resection.

Kobayashi K, Imagama S, Ito Z, Ando K, Yagi H, Shinjo R, Hida T, Ito K, Ishikawa Y, Matsuyama Y, Ishiguro N - Nagoya J Med Sci (2015)

Bottom Line: The patient was diagnosed with senile dementia by a psychiatrist.However, the patient's symptoms progressively worsened.However the patient died 29 days after admission, subsequently M. tuberculosis was detected in the CSF sample.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

ABSTRACT
Early-stage TB meningitis has no specific symptoms in patients, potentially leading to delayed diagnosis and consequently worsening prognosis. The authors present the fatal case with a delayed diagnosis of tuberculous (TB) meningitis with dementia as the presenting symptom after intramedullary spinal cord tumor resection. The medical records, operative reports, and radiographical imaging studies of a single patient were retrospectively reviewed. A 77-year-old man who underwent thoracic intramedullary hemangioblastoma resection for 2 times. The postoperative course was uneventful, but 1.5 months after surgery, the patient suffered from dementia with memory loss and diminished motivation and speech in the absence of a fever. No abnormalities were detected on blood test, brain computed tomography and cerebrospinal fluid (CSF) analysis. A sputum sample was negative for Mycobacterium tuberculosis in the QuantiFERON®-TB Gold (QFT-G) In-Tube Test and the tuberculin skin test was also negative. The patient was diagnosed with senile dementia by a psychiatrist. However, the patient's symptoms progressively worsened. Despite the absence of TB meningitis findings, we suspected TB meningitis from the patient's history, and administered a four-drug regimen. However the patient died 29 days after admission, subsequently M. tuberculosis was detected in the CSF sample. This case is a rare case of TB meningitis initially mistaken for dementia after intramedullary spinal cord tumor resection. Symptoms of dementia after intramedullary spinal cord tumor resection should first be suspected as one of TB meningitis, even if the tests for meningitis are negative. We propose that anti-tuberculosis therapy should be immediately initiated in cases of suspected TB meningitis prior to positive identification on culture.

No MeSH data available.


Related in: MedlinePlus

(a) T2 MRI after the first surgery, showing total resection of the tumor. (b) T2 MRI four years after the first surgery, showing regrowth of the tumor. (c) T2 MRI and (d) Gd enhanced MRI nine years after the first surgery.
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fig2: (a) T2 MRI after the first surgery, showing total resection of the tumor. (b) T2 MRI four years after the first surgery, showing regrowth of the tumor. (c) T2 MRI and (d) Gd enhanced MRI nine years after the first surgery.

Mentions: The patient was a 77-year-old man with recurrence of gait disturbance and dysuria. He had undergone resection of thoracic intramedullary hemangioblastoma 9 years ago (Fig. 1a,b). Gadolinium-enhanced magnetic resonance imaging (MRI) revealed tumor recurrence with syrinx formation (Fig. 2a-d). There were no abnormalities in blood tests and brain MRI. Reoperation was performed, and the pathological diagnosis was consistent with hemangioblastoma. The postoperative course was uneventful and he was discharged after regaining the ability to walk normally.


Tuberculous meningitis with dementia as the presenting symptom after intramedullary spinal cord tumor resection.

Kobayashi K, Imagama S, Ito Z, Ando K, Yagi H, Shinjo R, Hida T, Ito K, Ishikawa Y, Matsuyama Y, Ishiguro N - Nagoya J Med Sci (2015)

(a) T2 MRI after the first surgery, showing total resection of the tumor. (b) T2 MRI four years after the first surgery, showing regrowth of the tumor. (c) T2 MRI and (d) Gd enhanced MRI nine years after the first surgery.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664597&req=5

fig2: (a) T2 MRI after the first surgery, showing total resection of the tumor. (b) T2 MRI four years after the first surgery, showing regrowth of the tumor. (c) T2 MRI and (d) Gd enhanced MRI nine years after the first surgery.
Mentions: The patient was a 77-year-old man with recurrence of gait disturbance and dysuria. He had undergone resection of thoracic intramedullary hemangioblastoma 9 years ago (Fig. 1a,b). Gadolinium-enhanced magnetic resonance imaging (MRI) revealed tumor recurrence with syrinx formation (Fig. 2a-d). There were no abnormalities in blood tests and brain MRI. Reoperation was performed, and the pathological diagnosis was consistent with hemangioblastoma. The postoperative course was uneventful and he was discharged after regaining the ability to walk normally.

Bottom Line: The patient was diagnosed with senile dementia by a psychiatrist.However, the patient's symptoms progressively worsened.However the patient died 29 days after admission, subsequently M. tuberculosis was detected in the CSF sample.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

ABSTRACT
Early-stage TB meningitis has no specific symptoms in patients, potentially leading to delayed diagnosis and consequently worsening prognosis. The authors present the fatal case with a delayed diagnosis of tuberculous (TB) meningitis with dementia as the presenting symptom after intramedullary spinal cord tumor resection. The medical records, operative reports, and radiographical imaging studies of a single patient were retrospectively reviewed. A 77-year-old man who underwent thoracic intramedullary hemangioblastoma resection for 2 times. The postoperative course was uneventful, but 1.5 months after surgery, the patient suffered from dementia with memory loss and diminished motivation and speech in the absence of a fever. No abnormalities were detected on blood test, brain computed tomography and cerebrospinal fluid (CSF) analysis. A sputum sample was negative for Mycobacterium tuberculosis in the QuantiFERON®-TB Gold (QFT-G) In-Tube Test and the tuberculin skin test was also negative. The patient was diagnosed with senile dementia by a psychiatrist. However, the patient's symptoms progressively worsened. Despite the absence of TB meningitis findings, we suspected TB meningitis from the patient's history, and administered a four-drug regimen. However the patient died 29 days after admission, subsequently M. tuberculosis was detected in the CSF sample. This case is a rare case of TB meningitis initially mistaken for dementia after intramedullary spinal cord tumor resection. Symptoms of dementia after intramedullary spinal cord tumor resection should first be suspected as one of TB meningitis, even if the tests for meningitis are negative. We propose that anti-tuberculosis therapy should be immediately initiated in cases of suspected TB meningitis prior to positive identification on culture.

No MeSH data available.


Related in: MedlinePlus