title: Spinal cord involvement in tuberculous meningitis.
abstract: OBJECTIVE
  To summarize the incidence and spectrum of spinal cord-related complications in patients of tuberculous meningitis.
  
  
  METHODS
  Reports from multiple countries were included.
  
  
  METHODS
  An extensive review of the literature, published in English, was carried out using Scopus, PubMed and Google Scholar databases.
  
  
  RESULTS
  Tuberculous meningitis frequently affects the spinal cord and nerve roots. Initial evidence of spinal cord involvement came from post-mortem examination. Subsequent advancement in neuroimaging like conventional lumbar myelography, computed tomographic myelography and gadolinium-enhanced magnetic resonance-myelography have contributed immensely. Spinal involvement manifests in several forms, like tuberculous radiculomyelitis, spinal tuberculoma, myelitis, syringomyelia, vertebral tuberculosis and very rarely spinal tuberculous abscess. Frequently, tuberculous spinal arachnoiditis develops paradoxically. Infrequently, spinal cord involvement may even be asymptomatic. Spinal cord and spinal nerve involvement is demonstrated by diffuse enhancement of cord parenchyma, nerve roots and meninges on contrast-enhanced magnetic resonance imaging. High cerebrospinal fluid protein content is often a risk factor for arachnoiditis. The most important differential diagnosis of tuberculous arachnoiditis is meningeal carcinomatosis. Anti-tuberculosis therapy is the main stay of treatment for tuberculous meningitis. Higher doses of corticosteroids have been found effective. Surgery should be considered only when pathological confirmation is needed or there is significant spinal cord compression. The outcome in these patients has been unpredictable. Some reports observed excellent recovery and some reported unfavorable outcomes after surgical decompression and debridement.
  
  
  CONCLUSIONS
  Tuberculous meningitis is frequently associated with disabling spinal cord and radicular complications. Available treatment options are far from satisfactory.
authors.affiliation: Department of Neurology, King George Medical University, Uttar Pradesh, India.
authors.forename: R K
authors.initials: RK
authors.lastname: Garg
authors.affiliation: Department of Neurology, King George Medical University, Uttar Pradesh, India.
authors.forename: H S
authors.initials: HS
authors.lastname: Malhotra
authors.affiliation: Department of Neurology, King George Medical University, Uttar Pradesh, India.
authors.forename: R
authors.initials: R
authors.lastname: Gupta
mesh_terms: D003937:Diagnosis, Differential; D006801:Humans; D015994:Incidence; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy; D014390:Tuberculosis, Meningeal / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology* / Q000628:therapy