Rapidly Progressive Neurotuberculosis with Cerebral Infarction and Spinal Tuberculomas: A Case Report

Neurotuberculosis with Spinal Involvement

Abstract

Neurotuberculosis (NTB) is a rare but severe manifestation of tuberculosis that can affect the meninges, brain parenchyma, and spinal cord. It may lead to vascular complications such as infarction and hydrocephalus, resulting in significant morbidity. We present a rapidly progressive case of NTB in a thirty-one-year-old woman who was admitted with fever, vomiting, and altered mental status. Cerebrospinal fluid analysis showed elevated protein levels and hypoglycorrhachia, consistent with tuberculous meningitis. During hospitalization, brain MRI revealed diffusion restriction in the corpus callosum and parietal cortex, indicating infarction, while spinal MRI demonstrated leptomeningeal and dural enhancement. Subsequent imaging showed hydrocephalus and multiple contrast-enhancing nodules in the cerebellum and spinal cord, compatible with multifocal tuberculomas. Surgical excision of a spinal lesion confirmed caseating granulomatous inflammation with acid-fast bacilli, establishing the diagnosis of tuberculosis. This constellation of findings—vasculitic infarction, hydrocephalus, and multifocal intracranial and spinal tuberculomas—represents an exceptionally rare pattern of NTB. Recognition of these imaging features is crucial for early diagnosis and timely treatment, which are essential to prevent irreversible neurological sequelae.