111 Syringomyelia: a rare complication of TB meningitis

Introduction Syringomyelia is a rare but serious complication of tuberculous meningitis. Treatment with dexamethasone can reduce complication rates by reducing spinal inflammation. While anti-mycobacterial therapy is an important aspect of management, delay in its initiation diminishes its effectiveness. Surgical options such as ventricular drain and decompression are considered in some cases.Case Report We present a 30-year-old male who developed acute ataxia, past pointing, and tremors following his return from Nigeria. Initial imaging suggested TB meningitis and he was commenced on empirical anti-TB therapy and dexamethasone. However, his condition worsened to quadriplegia and decreased consciousness with an MRI showing severe spinal cord swelling and enhancing phlegmon occupying the entire spinal canal. This prompted the initiation of infliximab for a suspected paradoxical reaction. A repeat MRI later revealed a syrinx extending from C1 to C4.The mechanism of syrinx formation in this case may have involved persistent inflammation due to TB meningitis, leading to arachnoiditis and obstructed cerebrospinal fluid flow. This obstruction resulted in fluid accumulation within the spinal cord that expanded over time.Conclusion Syringomyelia is a rare and serious complication of tuberculous meningitis. It is important to be aware of it as a potential cause of neurological deterioration in relevant patients.aditya.adhikarla@mft.nhs.uk