Coexistence of Spinal Intramedullary and Intracranial Tuberculomas in a Child with Hemiparesis: A Case Report with Review of Literature

Background: While isolated spinal intramedullary tuberculomas are very rare, concurrent occurrence with intracranial tuberculoma is even more rare. Clinical Description: An 11-year-old, developmentally normal girl, presented with fever and right-sided hemiparesis for 2–4 weeks, with later onset seizures. Besides fever, vitals were stable. Neurological examination revealed right-sided upper motor neuron type hemiparesis, without cranial nerve involvement; other systems were normal. Management and Outcome: Routine blood investigations were normal. Magnetic resonance imaging (MRI) spine showed a few small hypointense lesions with mild cord expansion from the cervicomedullary junction to the C5 vertebral level, suggestive of intramedullary spinal cord tuberculomas, and MRI brain revealed the presence of multiple intracranial tuberculomas. Conservative treatment with antitubercular drugs and steroid showed complete clinic-oradiological improvement. Conclusion: Coexistence of intramedullary spinal and intracranial tuberculomas is an extremely rare condition. The clinical presentation and examination findings provide clues for the possibility of such dual-site lesions. An MRI of both the brain and spinal cord confirms the diagnosis. Conservative management, if started early, can result in recovery without the need for surgery.