Evaluation of cerebral arterial and venous system in tuberculous meningitis (original) (raw)
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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.
Journal of Clinical Neuroscience, 2007
Cerebral infarction as a complication of tubercular (TB) meningitis is not uncommon, but an adequate comparison of patients with and without stroke has not been carried out. This study was performed to evaluate the clinical characteristics of cerebral infarction secondary to TB meningitis, and to investigate predictive factors for cerebral infarction in patients with TB meningitis. Patients with TB meningitis were recruited over a period of 56 months. They were divided into two groups, those with and those without stroke. Demographic features and clinical, laboratory, and neuroradiological findings were compared between the two groups. We classified strokes into subtypes using neuroimaging findings. Of the 38 patients who were diagnosed with TB meningitis, eight also experienced cerebral infarction. The percentage of cerebrospinal fluid leukocytes that were neutrophils was significantly higher in patients with stroke (68%) than in patients without stroke (31%; p = 0.0001). Upon initial CT imaging, meningeal enhancement was found in 11 patients, and of these patients, six experienced stroke. There were no significant differences between the groups with respect to other clinical and laboratory features, including demographic features, time between meningitis onset and treatment initiation, peripheral white blood cell count, and cerebrospinal fluid findings. Five of the eight patients who developed stroke had lacunar infarcts. One of the three patients with territorial nonlacunar infarction died due to herniation. When treating patients with TB meningitis, the possibility of cerebral infarction should be considered when patients develop focal neurological signs, meningeal enhancement on a CT scan, and sustained polymorphic cerebrospinal fluid pleocytosis.
Journal of Neurosciences in Rural Practice
Objective The primary objective of the study was to assess the location of cerebral infarction and look for corresponding magnetic resonance angiography (MRA) changes in patients with tuberculous meningitis (TBM). We also evaluated the predictors of ischemic stroke in TBM and the impact of these infarctions on patient's outcome. Methods This was a single-center prospective study between September 2018 and September 2020. Demographic and laboratory parameters were noted. Cranial magnetic resonance imaging and MRA were performed at the time of admission to the hospital. Results Among 120 patients with TBM, 46 had stroke. Nineteen (15.8%) patients died, of which 12 (10%) suffered from stroke. The most common site of infarction was the basal ganglia (54.3%). The commonest site of MRA abnormalities was the middle cerebral artery (39.1%). British Medical Research Council (BMRC) stage 3, cerebrospinal fluid (CSF) sugar, CSF adenosine deaminase (ADA) level, basal exudates, hydrocephalus...
Magnetic resonance imaging, 2018
This study evaluated the prevalence and predictors of venographic abnormalities in tuberculous meningitis. Consecutive patients of tuberculous meningitis were included in the study. Clinical evaluation, cerebrospinal fluid examination and contrast-enhanced MRI of brain were done. Every subject was subjected to time of flight magnetic resonance venography (MRV). Presence of filling defects at superior sagittal sinus, dominant transverse or sigmoid sinus, and non-visualization of deep venous system was suggestive of thrombosis. The presence of filling defects at non-dominant transverse or sigmoid sinus was considered suggestive of thrombosis only in the presence of corresponding changes in T1, T2, and GRE sequences, parenchymal changes or presence of collaterals. The patients were followed up for 6 months. A modified Barthel index ≤12 at 6 months was taken as poor outcome. Out of 107 patients, MRV was found to be abnormal in 12 patients (11.2%). The superior sagittal sinus was the mos...
Frequency and Impact of Cerebral Infarctions in Patients With Tuberculous Meningitis
Stroke
Background and Purpose— Cerebral infarctions complicate a variable proportion of tuberculous meningitis (TBM) cases and adversely affect outcomes. The objective of this study was to evaluate the predictors of cerebral infarcts in patients with TBM and to assess their impact on mortality. Methods— The study was based on a retrospective chart review of all patients with TBM admitted to a tertiary care hospital between 2002 and 2013. Data were collected on basic demographics, conventional vascular risk factors, radiological findings, severity of TBM, and neurological outcomes. Data were analyzed using SPSS version 19.0. Binary logistic regression was done to determine the factors predictive of cerebral infarcts and of mortality in patients with TBM. Results— A total of 559 patients were admitted with TBM during the study period. Mean age was 41.9 years (SD, 17.7 years), and 47% were women. A quarter of the patients had stage III disease. One hundred forty-four (25.8%) patients had cere...
Ischemic infarction in 25 children with tuberculous meningitis
Stroke, 1988
Twenty-five cases (38%) of ischemic infarction occurred among 65 cases of tuberculous meningitis in patients less than 14 years of age. The male:female ratio was 1.3:1. The most frequent clinical findings were meningeal signs, fever, alteration of consciousness, cranial nerve involvement, seizures, and focal neurologic deficit. Twenty-three patients had anterior circulation infarcts, and two more had infarcts in the vertebrobasilar territories. Distribution of infarcts in the anterior circulation was shown by computed tomography in the territories of the following arteries: lenticulostriate, 10 cases unilateral and 6 bilateral; middle cerebral, 3 cases; internal carotid, 1 case; multiple areas, 3 cases. Of the 25 ischemic infarction cases, 23 (92%) had hydrocephalus, 19 (76%) basal exudates, and 2 (8%) tuberculomas. Outcome was poor since no patient with infarction recovered completely. Six died and bilateral subcortical infarcts led to a considerably higher mortality than unilatera...
Cortical venous thrombosis – a rare complication of tuberculous meningitis
2012
ABSTRACT: Occlusion of the central veins and sinuses occurs owing to thrombus, thrombophlebitis, or tumours. Cerebral venous thrombosis (CVT) is less frequent than arterial thrombosis, but can produce a cascade of sequelae and may be fatal. The usual predisposing factors for CVT include infections, pregnancy and puerperium, hypercoagulable states, etc. Many infectious causes are related to CVT, but a review of literature showed only few cases related to tuberculosis. Vascular changes consisting of arterial narrowing with or without occlusion are frequently seen at autopsy in cases of tuberculous meningitis. We report one such case of tuberculous meningitis where the patient developed cortical venous thrombosis after 5 days of illness. She was treated empirically, initially, till confirmation of the diagnosis and later was put on antitubercular drugs along with prednisolone therapy and anticoagulation, which led to complete recovery. Thus, if treated aggressively and in time, tubercu...
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.
Brain MRI findings in relation to clinical characteristics and outcome of tuberculous meningitis
PLOS ONE, 2020
Neuroradiological abnormalities in tuberculous meningitis (TBM) are common, but the exact relationship with clinical and inflammatory markers has not been well established. We performed magnetic resonance imaging (MRI) at baseline and after two months treatment to characterise neuroradiological patterns in a prospective cohort of adult TBM patients in Indonesia. We included 48 TBM patients (median age 30, 52% female, 8% HIV-infected), most of whom had grade II (90%), bacteriologically confirmed (71%) disease, without antituberculotic resistance. Most patients had more than one brain lesion (83%); baseline MRIs showed meningeal enhancement (89%), tuberculomas (77%), brain infarction (60%) and hydrocephalus (56%). We also performed an exploratory analysis associating MRI findings to clinical parameters, response to treatment, paradoxical reactions and survival. The presence of multiple brain lesion was associated with a lower Glasgow Coma Scale and more pronounced motor, lung, and CSF...