Illustration of spinal cord being healed, symbolizing recovery from tuberculoma

Spinal Tuberculoma: A Rare Cause of Paralysis and How to Treat It

Kai Mendoza in Health & Wellness December 2025 • 4 min read.

"Discovering a rare cause of progressive lower limb paresis and the critical role of early diagnosis and treatment."

Tuberculosis (TB) remains a significant global health concern, particularly in regions of Africa and Asia. While TB primarily affects the lungs, it can also involve the central nervous system (CNS), although this is less common. Spinal tuberculomas, a rare manifestation of CNS tuberculosis, account for a small fraction of all TB cases.

Spinal tuberculomas are infrequent, often presenting as a gradual compression of the spinal cord. Advances in imaging techniques like MRI have improved the ability to diagnose these lesions. This article explores a unique case of spinal tuberculoma, detailing its diagnosis and management, and emphasizing the importance of early intervention.

Focusing on a specific instance encountered in a neurosurgery department, we delve into the diagnostic process, treatment strategies, and patient outcomes associated with spinal tuberculoma. By examining epidemiological aspects, clinical presentations, radiological findings, and therapeutic approaches, this article aims to provide valuable insights into this rare condition.

Understanding Spinal Tuberculoma: Symptoms, Diagnosis, and Treatment

Illustration of spinal cord being healed, symbolizing recovery from tuberculoma

A 48-year-old male presented with increasing difficulty walking, accompanied by tingling sensations, back pain, and bladder issues. These symptoms had been worsening over two months. He also reported a low-grade fever and weight loss. His medical history was unremarkable, and there was no known exposure to TB.

Upon examination, the patient exhibited weakness and spasticity in both legs, impaired sensation, and exaggerated reflexes. Blood tests revealed mild anemia and an elevated sedimentation rate. HIV testing was negative. Initial myelography suggested a growth within the spinal cord, which prompted further investigation with MRI.

MRI Findings: The MRI revealed a heterogeneous lesion within the spinal cord, enhancing after contrast injection. This lesion also showed surrounding edema, suggesting inflammation.
Surgical Intervention: Based on these findings, a micro-surgical resection of the lesion was performed.
Pathological Diagnosis: Microscopic examination of the removed tissue confirmed the diagnosis of tuberculoma, characterized by caseous necrosis surrounded by epithelioid cells, giant cells, and lymphocytes.
Post-operative Course: Following surgery, the patient experienced partial recovery of motor function and bladder control. He was started on anti-tuberculosis medication for 10 months, along with rehabilitation therapy.
Follow-up: At 18-month follow-up, the patient had regained the ability to walk independently, and repeat MRI showed no recurrence of the lesion.

Spinal TB often occurs secondary to vertebral involvement (Pott's disease). However, the bacteria can directly infect the spinal cord. This leads to inflammation and granuloma formation. Spinal tuberculomas are less common than those in the brain, possibly due to differences in blood supply.

The Path to Recovery: Why Early Detection Matters

The diagnosis and treatment of spinal tuberculoma require a high index of suspicion, especially in regions where TB is prevalent. MRI plays a crucial role in identifying these lesions, allowing for timely intervention.

While the optimal management strategy remains debated, a combination of surgical resection and anti-tuberculosis therapy is often employed. Corticosteroids may also be considered to reduce inflammation, although their effectiveness is not definitively established.

Spinal tuberculoma, though rare, can be effectively managed with prompt diagnosis and appropriate treatment. Advances in neuroimaging, microsurgical techniques, and anti-tuberculosis medications have significantly improved outcomes for affected individuals.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.4314/ajns.v27i2.55122, Alternate LINK

Title: Le Tuberculome Intra Medullaire : Une Cause Rare De Paraparesie

Subject: Neurology (clinical)

Journal: African Journal of Neurological Sciences

Publisher: African Journals Online (AJOL)

Authors: A Haidara, G Varlet, D N’Dri Oka, M Broalet, B Doukoure, H N’Da Herman, K Drogba

Published: 2010-06-03

Everything You Need To Know

What is Spinal tuberculoma?

Spinal tuberculoma is a rare manifestation of tuberculosis that affects the central nervous system. It's a specific form of tuberculosis where a granuloma (a mass of inflamed tissue) forms within the spinal cord. This can lead to compression of the spinal cord, causing various neurological symptoms, including paralysis. Unlike typical TB, Spinal tuberculoma often presents with gradual compression of the spinal cord. Diagnosis involves imaging techniques like MRI, and treatment usually includes surgery and anti-tuberculosis medication.

What are the common symptoms of Spinal tuberculoma?

The symptoms of Spinal tuberculoma can include increasing difficulty walking, tingling sensations, back pain, and bladder issues. There might also be a low-grade fever and weight loss. As the condition progresses, patients can develop weakness and spasticity in their legs, along with impaired sensation and exaggerated reflexes. The symptoms arise because the Spinal tuberculoma compresses the spinal cord, disrupting the normal function of the nerves.

Why is early diagnosis important for Spinal tuberculoma?

Early diagnosis of Spinal tuberculoma is important because timely intervention can prevent or minimize permanent neurological damage, such as paralysis. MRI is critical for identifying these lesions, which allows for prompt surgical intervention and the initiation of anti-tuberculosis medication. Early treatment can lead to significant recovery of motor function and bladder control, as highlighted in the case study.

How is Spinal tuberculoma diagnosed?

The diagnostic process typically involves a combination of clinical evaluation, imaging, and pathological examination. Initial assessment includes a review of the patient's symptoms and medical history. Blood tests, such as an elevated sedimentation rate, might indicate inflammation. However, MRI is crucial for visualizing the lesion within the spinal cord. Following surgical intervention, the removed tissue is examined under a microscope to confirm the diagnosis of tuberculoma, characterized by caseous necrosis surrounded by epithelioid cells, giant cells, and lymphocytes. This confirms the presence of Spinal tuberculoma.

How is Spinal tuberculoma treated?

The treatment for Spinal tuberculoma generally involves a combination of surgery and anti-tuberculosis medication. Surgery, like the micro-surgical resection of the lesion, is performed to decompress the spinal cord. After surgery, the patient undergoes a course of anti-tuberculosis medication, often for an extended period. The specific medication and duration depend on the individual case and the response to treatment. In addition, rehabilitation therapy can help the patient regain motor function and improve their quality of life. Successful treatment can result in a full recovery, as seen in the follow-up of the patient regaining the ability to walk independently.