Pratibha Prasad et al JMSCR Volume 06 Issue 02 February 2018 Page 625 JMSCR Vol||06||Issue||02||Page 625-628||February 2018 Intra Medullary Tuberculoma Presenting as Brown Sequard Syndrome with Concurrent Intradural Extramedullary Tuberculoma and Arachnoiditis Authors Pratibha Prasad 1 , Amita Bhargava 2 , Khichar Shubhakaran 3 1 D.M. Neurology, Senior Resident, Department of Neurology , Dr. S.N. Medical College, Rajasthan University Of Health Science, Jodhpur – 342001, Rajasthan, India 2 D.M. Neurology, Professor and Head, Department of Neurology, Dr. S.N. Medical College , Rajasthan University Of Health Science, Jodhpur – 342001, Rajasthan, India 3 D.M. Neurology, Professor, Department of Neurology , Dr. S.N. Medical College , Rajasthan University Of Health Science, Jodhpur – 342001, Rajasthan, India Abstract Intramedullary and intradural-extramedullary spinal tuberculomas causing spinal cord compression is an uncommon entity. We report an unique case of a 27-year-old Indian male patient on 4 drug antituberculous chemotherapy for tubercular meningitis , who presented after two months with rapidly progressive unilateral lower limb monoparesis with loss of pain and temperature in the contralateral limb but intact position and vibration sense. MRI spine showed a single intramedullary tuberculoma at D2-D3 level, might causing brown sequard syndrome, associated with multiple intradural-extramedullary tuberculomas in thoracic and cervical region with arachnoiditis. MRI brain showed no evidence of intracranial tuberculoma. In our case the patient was given high dose steroid to which he responded and later discharged on antituberculous therapy and oral steroids. This case is being reported owing to its rarity of its presentation as brown sequard syndrome and co-occurrence of both intramedullary and intradural-extramedullary tuberculomas in an immunocempetent patient. Keywords: Intramedullary, Intradural-extramedullary Tuberculoma, Brown-Sequard-Syndrome. Introduction Tuberculosis still remains endemic in developing countries such as Asia and Africa. The brain is more commonly affected than the spinal cord, the ratio being 42:1. This may be due to the relative masses of neural tissue in them. (1) Intramedullary tuberculomas is a lesion extremelly rare seen only in 2 of 100, 000 cases of tuberculosis and 2 of 1000 cases of tuberculosis of central nervous systems disesase. (2) Our patient , on two months of antitubercular therapy (ATT) for tubercular meningitis (TBM), presented with atypical brown sequard syndrome (BSS) who was later confirmed to be a case of concomitant intramedullary and intradural-extramedullary (IDEM) tuberculomas of spine with arachnoiditis. We report this case owing to its rarity of its presentation as atypical BSS and coexistence of both intramedullary and IDEM tuberculoma. www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 71.58 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i2.97