Craniovertebral junction tuberculosis: A review of 29 cases

Purpose: The purpose of this work was to describe the various imaging findi ngs in craniovertebral tuberculosis and the importance of imaging in treatm ent in these patients. Method: A retrospective review of MR and CT scans in 29 patients with crani overtebral tuberculosis was performed. The images were reviewed, paying spe cial attention to bath bony (skull base, atlas, and axis) and soft tissue i nvolvement in addition to atlantoaxial dislocation, lateral subluxation of the dens, and compression of the spinal cord. Results: Suboccipital pain with neck stiffness was the most common presenti ng symptom in our patients, The skull was involved in 19 of the 29 cases, c livus involvement was seen in 11 patients, and occipital condyle involvemen t was present in 14 patients. Detailed analysis of atlas involvement due to tuberculosis showed the lateral masses to be predominantly affected. The d ens was involved in 18 cases (62%). Soft tissue masses in the prevertebral area were seen in 22 patients, paravertebral in 27 patients, and epidural i nvolvement in 25 patients was identified. Atlantoaxial displacement was pre sent in seven cases, lateral mass-dens subluxation in five, and superior su bluxation of the dens through the foramen magnum compressing the medulla wa s seen in two cases. Spinal cord compression with intrinsic cord changes wa s noted in 12 cases. All patients received multidrug antituberculous therap y for 1 year. The presence of neurologic deficit and instability of the atl antoaxial complex was pivotal in further management in these patients. Conclusion: A high degree of clinical suspicion is necessary when confronte d with patients with neck stiffness and tenderness over the upper cervical vertebrae. MRI in these patients provides a sensitive method for the diagno sis of craniovertebral tuberculosis.