Intramedullary tuberculoma of lumber spinal cord presented as paraparesis

ABSTRACT Intramedullary tuberculoma, a rare form of central nervous system tuberculosis (TB), presents significant diagnostic and therapeutic challenges due to its rarity and variable clinical manifestations. This case highlights a 20-year-old female with a history of abdominal TB presenting with acute neurological symptoms, emphasizing the importance of timely recognition and management. Intramedullary tuberculoma is an uncommon extrapulmonary manifestation of TB, resulting from hematogenous spread of Mycobacterium TB. It often mimics other neurological conditions, such as Guillain–Barré Syndrome and transverse myelitis, necessitating high clinical suspicion and advanced imaging for accurate diagnosis. Management combines ATT to eradicate the infection and corticosteroids to mitigate inflammation and mass effects. A young female presented with an 8-day history of high-grade fever, vomiting, diarrhea, and progressive bilateral lower limb weakness and pain. Neurological examination revealed flaccid tone, impaired spinothalamic sensations, extensor plantar reflexes, and absent deep tendon reflexes in the lower limbs. Investigations included normal routine laboratory results and cerebrospinal fluid analysis, while contrast-enhanced magnetic resonance imaging of the spine revealed a ring-enhancing lesion at the L1 level, suggestive of intramedullary tuberculoma. This case underscores the critical need for early diagnosis and treatment of intramedullary tuberculoma to improve outcomes and prevent permanent neurological deficits in patients with a history of inadequately treated TB.