====== Foramen magnum tuberculoma ======

[[Intradural]] [[extramedullar]]y (IDEM) [[tuberculoma]] at the [[foramen magnum]] is rare, and mimics [[en plaque meningioma]]. 

Kolakshyapati et al., from the Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, [[Hiroshima]] University, [[Japan]], [[report]] the case of a 53-year-old woman who presented with [[dysesthesia]] of the [[tongue]] and [[lower cranial nerve]] (CN) [[palsy]], with onset 4 months prior to [[admission]]. The neurologic [[examination]] revealed left upper-limb [[weakness]] and [[hypoesthesia]] on the sole and dorsum of the left foot. Other physical examinations revealed no features of tubercular infection. [[Laboratory]] [[investigation]]s likewise showed no [[sign]]s of [[infection]] or [[inflammation]]. Magnetic resonance imaging of the brain showed an IDEM mass originating from the left intradural surface at the [[foramen magnum]] extending to the [[C2]] segment and compressing the [[brainstem]] and upper cervical cord. The mass was [[isointense]]/[[hypointense]] on T1- and T2-weighted images and homogeneously-enhanced on postcontrast images. The lesion also exhibited the dural-tail sign and was preoperatively diagnosed as en plaque meningioma. The patient underwent surgery via the left [[transcondylar approach]] with partial laminectomy of the [[atlas]]. Intraoperatively, the mass exhibited a dural origin and encased the [[vertebral artery]] and lower CNs, with strong adhesions. While the histopathological study of the mass was strongly suggestive of [[tuberculoma]] with multifocal [[granuloma]]s, caseous necrosis, and [[Langhans giant cell]]s, extensive diagnostic studies failed to detect [[Mycobacterium tuberculosis]] itself. Although the patient had recurrence with multisystem involvement, she responded well to antitubercular treatment. IDEM tuberculoma of the foramen magnum may present as [[en plaque meningioma]]. [[Histopathology]] is required for a definitive diagnosis. Prompt surgical resection and decompression with adequate antitubercular treatment yield better neurological outcomes
((Kolakshyapati M, Takeda M, Mitsuhara T, Yamaguchi S, Abiko M, Matsuda S,
Kurisu K. Isolated Tuberculoma Mimicking [[Foramen Magnum Meningioma]] in the Absence
of Primary Tuberculosis: A Case Report. Neurospine. 2018 Aug 27. doi:
10.14245/ns.1836034.017. [Epub ahead of print] PubMed PMID: 30145853.
)).