Abstract

Syringomyelia associated with tuberculous meningitis is an extremely rare condition. Only a few studies have reported clinical experience with syringomyelia as a late complication of tuberculous meningitis. Twenty-six years after a tuberculous meningitis episode, a 44-year-old man presented with progressively worsening spastic paresis of the lower limbs and impaired urinary function for 2 years. Radiological examination revealed syringomyelia extending from the level of C2 to T9 and arachnoiditis with atrophy of the spinal cord between C2 and T3. We performed laminectomy from C7 to T1, dissected the arachnoid adhesion and placed a syringo-pleural shunt via keyhole myelotomy. One year after the operation, his neurological condition improved. The postoperative control magnetic resonance imaging revealed the correctly located shunt and significantly diminished syringomyelia cavities. We aim to discuss the mechanism of syrinx formation following tuberculous meningitis and to share our surgical therapeutic experience with this rare disease entity.

Keywords: Cerebrospinal fluid shunts, Syringomyelia, Tuberculosis, meningeal
 
 

Introduction

Tuberculous meningitis is not a rare disease, as it is one of the most common extrapulmonary manifestations of tuberculosis. However, syringomyelia following tuberculous meningitis is an extremely rare condition. Very few cases of this condition have been reported previously. Previous reports described extensive adhesive arachnoiditis and multiple lobule formation; surgical attempts failed to improve the neurological status of these patients.

We report a case of syringomyelia secondary to an inflammatory arachnoiditis owing to tuberculous meningitis, which we were able to successfully treat by performing microsurgical dissection and placing a syringo-pleural shunt.