Unusual presentations of craniovertebral junction tuberculosis: a report of 2 cases and literature review.
BACKGROUND
CVJ tuberculosis is a described entity requiring challenging ways of management. Severe neck pain, causing restricted neck movements and torticollis, is a characteristic presentation of neurologically asymptomatic suboccipital Pott's disease.


METHODS
Two patients with unusual CVJ tuberculosis form the basis for the present communication. The first patient presented with tubercular otitis media, causing progressive erosion of the petrous part of temporal bone, and destruction of the occipital condyle, along with the lateral mass of atlas, leading to CVJ instability. This is a first report of such a presentation, according to our knowledge. Detailed bony architectural destruction demonstrable on CT scan has been described. The second patient, with CVJ tuberculosis, presented with skull base syndrome and with multiple cranial nerve palsies. Both patients were managed without surgical intervention and showed clinical and radiological recovery.


CONCLUSIONS
In such patients with unusual clinical presentations, histopathologic examination is necessary to arrive at a correct diagnosis. The management of patients with tubercular involvement of CVJ remains controversial. In the present communication, both the patients were managed successfully with full dose of antitubercular drugs and immobilization.
Mohindra
Sandeep
S
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India. satya_sandee@yahoo.com
Gupta
Sunil Kumar
SK
Mohindra
Satyawati
S
Gupta
Rahul
R
D000328:Adult; D001368:Axis, Cervical Vertebra / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D001270:Cervical Atlas / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D003389:Cranial Nerve Diseases / Q000175:diagnosis / Q000382:microbiology / Q000503:physiopathology; D018450:Disease Progression; D004432:Ear, Middle / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007002:Hypoglossal Nerve / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology; D007194:India; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000175:diagnosis / Q000382:microbiology / Q000503:physiopathology; D009777:Occipital Bone / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D010033:Otitis Media / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D019291:Skull Base / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D013701:Temporal Bone / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D014057:Tomography, X-Ray Computed; D014399:Tuberculosis, Spinal / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D014630:Vagus Nerve / Q000382:microbiology / Q000473:pathology / Q000503:physiopathology