Concurrent intracerebral and intramedullary spinal tuberculomas in an immunocompetent individual

A 28-year-old Indian man presented to us with progressive weakness of both lower limbs of 1 month duration. His physical examination revealed spastic paraparesis with a power of 2/5, bilateral lower limb hyper-reflexia and positive Babinski sign. His routine blood tests were within normal limits and he was negative for HIV ELISA. His chest X-ray showed bilateral multiple miliary shadows (figure 1). MRI of the spine performed for the evaluation of paraparesis showed multiple intramedullary ring enhancing lesions extending from D6 level up to the conus, with perifocal oedema (figure 2). MRI of the brain showed multiple well-defined ring enhancing lesions with perilesional oedema scattered diffusely …