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Tuberculous myelitis: a systematic review of published case reports and case series
Ravindra Kumar Garg1, Neeraj Kumar2, Ravi Uniyal2
1Department of Neurology, King George's Medical University, Lucknow, 226003, India. garg50@yahoo.com.
Study Design:
A systematic review.
Objectives:
Tuberculous myelitis, an uncommon disorder, often manifests as transverse myelopathy. The majority of the literature comprises isolated case reports, necessitating a systematic review for better understanding and management.
Setting:
Uttar Pradesh India.
Methods:
Our review followed PRISMA guidelines, searching PubMed, Scopus, Embase, and Google Scholar with no language constraints. Quality assessment of reports was based on selection, ascertainment, causality, and reporting. Data synthesis was qualitative with categorical and continuous data representation.
Results:
We analyzed 34 reports describing 39 individuals. The majority (85%) had a duration of illness of one month or less. Upper motor neuron paraparesis was the most common neurological manifestation (69.2%), followed by areflexic paraparesis (15.3%). Paradoxical reactions occurred in 20.5% of cases. Microbiological confirmation was achievable in approximately 77% of cases. Neuroimaging abnormalities were present in 41% of cases, and chest imaging abnormalities in 53.9%. Longitudinally-extensive hyperintensities in cervical and thoracic regions were common spinal imaging abnormalities. Central nervous system tuberculosis was confirmed in 47.7% of cases, while pulmonary and disseminated tuberculosis were each found in 25.6%. Improvement was noted in 87.2% of cases, while 10.3% did not improve or died.
Conclusion:
Tuberculous myelitis, is a distinct spinal cord disease. Most cases had microbiological confirmation, and the majority showed improvement with treatment.
Insights
Tuberculous myelitis, a rare spinal cord disease, often presents as transverse myelopathy. This systematic review found most patients improved with treatment, with microbiological confirmation in most cases.
Area of Science:
- Neurology
- Infectious Diseases
- Spinal Cord Disorders
Background:
- Tuberculous myelitis is an uncommon neurological disorder.
- Literature primarily consists of isolated case reports.
- A systematic review is needed for comprehensive understanding and management.
Purpose of the Study:
- To systematically review tuberculous myelitis cases.
- To understand the clinical manifestations, diagnosis, and outcomes.
- To inform management strategies for this rare condition.
Main Methods:
- Systematic review following PRISMA guidelines.
- Searched PubMed, Scopus, Embase, and Google Scholar.
- Analyzed 34 reports of 39 individuals with qualitative data synthesis.
Main Results:
- Most cases (85%) had illness duration ≤1 month.
- Upper motor neuron paraparesis (69.2%) was the most common symptom.
- Microbiological confirmation was achieved in ~77%; 87.2% improved with treatment.
Conclusions:
- Tuberculous myelitis is a distinct spinal cord disease.
- Microbiological confirmation is often achievable.
- The majority of patients experience improvement with appropriate treatment.
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