European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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This study was carried out to identify the distinguishing features of brucellosis on magnetic resonance imaging (MRI). MRI examinations were performed in 14 patients with spinal brucellosis. A 1-T Magnetom (Erlangen, Siemens) was used to obtain T1-weighted (TR/TE 500/30) and T2-weighted (TR/TE 2000/80/20) spin echo sequences, in both sagittal and axial planes. ⋯ Seven facet joints of five patients with discitis displayed signal increase after contrast enhancement. Vertebral body signal changes without morphologic changes marked signal increase in the intervertebral disc on T2-weighted and contrast-enhanced sequences, and soft tissue involvement without abscess formation can be accepted as specific MRI features of brucellar spondylitis. The facet joint signal changes following contrast enhancement is another MRI sign of spinal brucellosis, which has not been mentioned so far.
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Tuberculosis of the craniovertebral region is very rare. Neural deficit in this region is reported in between 24% and 64% of cases, and mainly takes the form of quadriparesis. Hemiplegic and monoplegic presentation among this set of patients is rarer. ⋯ Hemi/monoplegic presentation is extremely rare; no author in the literature is able to give reason for the rarity or the pathomechanics of the condition. We believe that if medullary cervical junctional involvement extends slightly higher (in rare circumstances), with involvement of one of the branches of the vertebral or lower basilar artery, medial medullary syndrome will occur, sparing medial lemniscus and emerging hypoglossal nerve fibres. Thus the pyramids will be involved, causing contralateral hemiparesis, and if the pyramids are selectively involved, it will cause contralateral monoparesis.