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Management of syringomyelia associated with tuberculous meningitis: A case report and systematic review of the literature

  • Nivedha V. Kannapadi
    Affiliations
    Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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  • Safwan O. Alomari
    Affiliations
    Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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  • Giorgio Caturegli
    Affiliations
    Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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  • Ali Bydon
    Affiliations
    Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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  • Sung-Min Cho
    Correspondence
    Corresponding author at: Department of Anesthesiology and Critical Care Medicine, Division of NCCU Johns Hopkins Medical Institutions, 600 N. Wolfe Street, Phipps 455, Baltimore, MD 21287, United States.
    Affiliations
    Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine and Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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      Highlights

      • Syringomyelia is a rare but serious complication of tuberculous meningitis.
      • TB syringomyelia is often refractory to both surgical and medical management.
      • Surgery does not have significantly better outcomes than medical management.

      Abstract

      Determinants of tuberculosis (TB) syringomyelia, its management options and outcomes are still under investigation. The aim of this study is to present a case of TB syringomyelia with markedly improved symptoms status-post surgery and to understand the clinical characteristics and outcomes of 33 TB syringomyelia cases reported in the literature. Specifically, we examined the differences between patients who were managed medically and those who underwent surgical intervention. Inclusion criteria for the cases were (1) syringomyelia caused by TB infection rather than co-occurrence of these conditions, (2) management protocol described, and (3) post-treatment outcome described. The median age was 30 years (interquartile range (IQR): 23–40) with 55% males. The median time between TB onset to syringomyelia diagnosis was 2 years. Nineteen patients were surgically treated, 11 were medically treated, and 3 received no treatment. Twenty-one patients showed improvement in at least one prior symptom, but no patient experienced a full recovery. Those that underwent surgical intervention were more likely to have TB meningitis (95% vs. 64%, p < 0.05) upon initial TB presentation and have a greater interval between TB onset and syringomyelia presentation (median of 2.6 vs. 0.33 years, ns). A greater proportion of the surgically managed patients experienced improvement in any symptom (74% vs. 45%, ns). Future case-controlled studies with larger sample sizes are required to validate and further understand the outcomes of surgically-managed TB syringomyelia.

      Keywords

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