Intramedullary spinal tuberculomas during treatment of tuberculous meningitis

A case of multiple intramedullary spinal tuberculomas developing paradoxically during effective treatment of tuberculous meningitis is described. Serial MR imagings with Gd-DTPA enhancement studies showed initial homogeneous enhanced lesion representing myelitis or the early tuberculoma stage, which evolved to show ring enhancement with hypointense center later. Their appearance was similar to those described in brain tuberculoma. Gd-DTPA enhancement MR imaging is more sensitive than MR imaging without enhancement in demonstrating the lesions of tuberculoma and arachnoiditis. Antituberculous medication was effective with marked clinical improvement.