Cortical venous thrombosis – a rare complication of tuberculous meningitis (original) (raw)
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The Indian Journal of Pediatrics, 2019
Stroke is common in tuberculous meningitis. Stroke commonly affects the tubercular zone, comprising the anterior part of the thalamus, caudate and the internal capsule (anterior limb and genu). Stroke, in tuberculous meningitis is predominantly arterial ischemic stroke, and is due to infiltrative, proliferative or necrotizing arteritis. Rarely, aneurysm formation and mycotic aneurysms have also been described. The authors describe the clinical and autopsy findings of a 27-mo-old boy with tuberculous meningitis whose course was complicated by arterial and venous strokes, and nonresponse to adequate and appropriate antitubercular therapy.
Evaluation of cerebral arterial and venous system in tuberculous meningitis
Journal of neuroradiology. Journal de neuroradiologie, 2017
Central nervous system infection especially pyogenic results in cerebral venous sinus thrombosis. Tuberculous meningitis (TBM) although associated with infarctions but there is no comprehensive study evaluating the role of CVST contributing in infarction PURPOSE: To evaluate cerebral arterial and venous system using MR angiography (MRA) and MR venography (MRV) in TBM, and correlate with clinical and MRI findings. Consecutive patients with TBM were evaluated clinically and their consciousness was assessed by using Glasgow Coma scale.Cerebrospinal fluid analysis was done. Patients were subjected to MRI, MRA and MRV studies.The severity of TBM was categorized as grade I to III. Presence of infarction on MRI and its cause as arterial or venous was noted based on MRA and MRV abnormalities. 26 patients were included whose median age was 23 years. 7(26.9%) patients had stage I, 12 (46.2%) stage II and 7 (26.9%) stage III TBM. MRI revealed infarction in 13(50%) patients and were in tubercul...
Cerebral infarction pattern in tuberculous meningitis
Scientific Reports, 2016
Tuberculous meningitis (TBM) causes significant morbidity and mortality. The primary objective was to reexamine the concept of "TB zone" and "ischaemic zone" in cerebral infarction in patients with tuberculous meningitis. The secondary objective was to evaluate cerebral infarction, vasculitis and vasospasm in tuberculous meningitis infections. Between 2009 and 2014, TBM patients were recruited. Neuroimaging was performed and findings of cerebral infarction, vasculitis and vasospasm were recorded. Infarcts were classified based on arterial supply and Hsieh's classification. Fifty-one TBM patients were recruited of whom 34 patients (67%) had cerebral infarction. Based on Hsieh's classification, 20 patients (59%) had infarcts in both "TB zone" and "ischaemic zones". 12 patients (35%) had infarcts in "ischaemic zone" and two (6%) patients had infarcts in "TB zone". In terms of vascular supply, almost all patients (35/36) had infarcts involving perforators and cortical branches. 25 patients (73%) and 14 patients (41%) had infarcts supplied by lateral lenticulostriate and medial lenticulostriate arteries respectively. 15 patients (37%) had vasculitis. Vasospasm was present in six patients (15%). 29 patients (85%) with cerebral infarction also had leptomeningeal enhancement (p = 0.002). In summary, infarcts involved mainly perforators and cortical branches, rather than "TB zone" versus "ischaemic zone". As we entered the second decade of the twenty first century, tuberculosis (TB) remained an infection of global importance. In 2012, there were 8.6 million new and 1.3 million deaths due to tuberculosis 1. Tuberculous meningitis (TBM) occurs in 4% of patients with tuberculosis 2. Tuberculous meningitis causes significant morbidity and mortality, especially if diagnosis and treatment are late 1. Cerebral infarction occurs in 15-57% of tuberculous meningitis patients, mainly during stage three of the illness 3. According to a study published by Hsieh and colleagues, 75% of infarcts occurred in the "TB zone" supplied by the medial lenticulostriate and thalamoperforating arteries, whereas only 11% occurred in the "ischaemic zone" supplied by the lateral lenticulostriate, anterior choroidal and thalamogeniculate arteries 4. This concept has been widely accepted. For example, it was discussed in a review on stroke in tuberculous meningitis in 2011 3 , and also in a chapter on tuberculous meningitis of an important neurology textbook on tuberculous meningitis in the developing world 5. The primary objective of the present study was to reexamine the concept of "TB zone" and "ischaemic zone" in cerebral infarction in patients with tuberculous meningitis. The secondary objective was to evaluate cerebral infarction, vasculitis and vasospasm in tuberculous meningitis infections. Methodology This study was a transversal descriptive study on the patients with tuberculous meningitis.
Acute Stroke Secondary to Tuberculous Meningitis: A Case Report and Review of Literature
Ischemic stroke is a sudden onset of a focal neurologic deficit that can cause morbidity and mortality in the countries. The etiology of ischemic stroke is so numerous. Cerebral vasculitis secondary to tuberculous meningitis is a rare cause of it. We report a 27-year old male man who developed multiple cerebral infarctions as the first manifestation of tuberculous meningitis and discusses that full work up for every patient with atypical and young stroke should be done.
UNUSUAL PRESENTATION OF TUBERCULOUS MENINGITIS: TWO CASE REPORTS
Tubercular meningitis can be a great mimicker with varied manifestations. Here we present two cases with extremely unusual presentations. First case is of a 22 year boy who presented with 2 weeks history of headache following a minor accidental fall and blunt injury to head and was diagnosed as tubercular meningitis .Second case is a 42 year old man presented with 6 months history of fever and followed by a stroke involving the left capsulogangionic region and diagnosed as tubercular meningitis. First case presented without fever or other features of meningitis while second case had prolonged 6 months fever followed by Vasculitic infarcts related to tuberculosis without any other systemic organ involvement.
Journal of Emergency Medicine and Intensive Care, 2015
Tuberculosis is a chronic necrotizing granulomatous disease caused by Mycobacterium tuberculosis, causes morbidity and mortality worldwide, and affects children as in all age groups. Tuberculous meningitis (TM) is the most severe form of the disease. The pathogenesis of TM is poorly understood and the best management has not been established. We report 17-years old female patient, who was referred from Somalia with a suspected intracranial mass lesion accompanied by poor general condition, reduced consciousness, hypertension and bradycardia, diagnosed as TM after brain biopsy with result of positive PCR and culture for M. tuberculosis. But the patient died after diagnosis of tuberculous meningitis in the last phase. The aim of this case report is to remind that TM must be considered in the differential diagnosis of intracranial infection in patients from endemic areas and the treatment should be initiated rapidly to prevent delayed diagnosis and lethal complications.
Tuberculosis: an uncommon cause of cerebral venous thrombosis?
Arquivos de Neuro-Psiquiatria, 2005
Several infectious etiologies are related to cerebral venous thrombosis (CVT), but a review of l i t e r a t u reshowed only few cases related to tuberculosis (TB), and only one with neurological manifestat i o n s . We re p o rt an unusual case of CVT related to TB and mutation in pro t h rombin gene. A 38-man black p resented abrupt right hemiparestesis, and hemiparesis. Investigations revealed CVT. Cerebral spinal flui d (CSF) examination evidenced a infection by Mycobacterium. He was heterozygous for G20210A pro t h ro mbin mutation. Pro b a b l y, hypercoagulability mechanisms of TB, added to mutation of pro t h rombim gene increase the risk of CVT.
Rare Clinical Presentation of Tuberculous Meningitis: A Case Report
The Malaysian journal of medical sciences : MJMS, 2017
Tuberculosis is the second leading cause of death under the category of infectious diseases, after the human immunodeficiency virus (HIV). Tuberculous meningitis (TBM) constitutes about 5% of all extrapulmonary disease worldwide. This report describes a case of Tuberculous meningitis with rare presentation in a 28-year-old woman, who was treated based on a collection of her social background, clinical findings and Multiplex PCR of tuberculosis. A 28-year-old Malay woman with no significant medical history presented to HUSM with one month history of on and off fever, two weeks history of generalised limbs weakness and one week history of dysphagia. She was reported to have experienced visual hallucination and significant weight loss. Her laboratory result is significant for leukocytosis, elevated ESR and hypernatremia. Non-enhanced and contrast CT scan of the brain showed severe bilateral frontal cerebral atrophy. Cerebral spinal fluid (CSF) for multiplex PCR for complex was positive...