SCI
Wassim Drissi, DO
Doctor
Mayo Clinic
Rochester, Minnesota, United States
Ronald Reeves, MD
Associate Professor of Physical Medicine and Rehabilitation
Mayo Clinic
Rochester, Minnesota, United States
Wassim Drissi, DO
Mayo Clinic
Rochester, Minnesota, United States
Infection-related myelopathy represents only a small percentage of spinal cord injury patients treated on inpatient rehabilitation units, and tuberculosis cases in the US are only a small part of that group. Tuberculosis associated myelitis is rare in the US. We report a 21-year-old female who presented with subacute headache, stiff neck, and fever. Initially treated as bacterial meningitis, she developed progressive paraparesis and numbness below her waist. MRI revealed lesions consistent with tuberculosis meningitis and subarachnoid enhancement. She was ultimately treated with high-dose rifampin, isoniazid, pyrazinamide, levofloxacin, and a steroid course.
During inpatient rehabilitation, she demonstrated gradual motor recovery but had persistent weakness. Exam revealed spastic paraparesis, a left cranial nerve VI palsy, and preserved upper extremity strength. Rehabilitation was complicated by language barriers and challenges with regards to equipment and medication acquisition. Months after discharge, she completed tuberculosis treatment, resumed college, and was modified independent from a wheelchair base.
Discussions:
This case illustrates the complications of CNS tuberculosis, including vasculitis, myelitis, spastic paraparesis, and thromboembolism. Tuberculosis meningitis can mimic other processes, making swift diagnosis essential. Intensified antituberculosis regimens with high-dose rifampin, fluoroquinolones, and adjuvant corticosteroids reduce mortality. Persistent deficits highlight the importance of rehabilitation, while barriers such as language and equipment access influence recovery. Ultimately, tuberculosis spinal myelopathy has excellent neurologic recovery exceeding 90% with prompt pharmacologic treatment.
Conclusions:
Tuberculosis meningitis may present with severe motor, vascular, and neurologic complications that adversely affect functional status. This case highlights the need for clinical suspicion, prompt empiric therapy, and management of complications to reduce long-term disability.
