An intramedullary mass

A man in his 30s presented with one month of progressive bilateral numbness and paralysis in the lower extremities. He had a history of pulmonary tuberculosis two years earlier, which resolved after treatment with isoniazid, rifampicin, and ethambutol. Physical examination showed hypoesthesia below the level of T10; grade I strength in the bilateral iliopsoas, quadriceps femoris, and tibialis anterior muscles; and bilateral lower extremity hyperreflexia. Gadolinium enhanced magnetic resonance imaging (MRI) detected a mass in the thoracic canal (fig 1). Fig 1 Gadolinium enhanced MRI of the thoracic spine (sagittal plane) showing a “target” sign—a ring enhancing intramedullary lesion with a clear border measuring 0.8 cm×3.0 cm×0.8 cm (red arrows) …