Cerebral Infarcts Complicating Tuberculous Meningitis

Abstract

Cerebral infarction (CI) is a serious complication of tuberculous meningitis (TBM). It can be asymptomatic or symptomatic, causing stroke. We studied 40 TBM patients. All had initial CT brain scan, CT/MRI brain scan 3 months later and urgent CT brain scan for deterioration. CI was classified into lacunar infarction (LI) or large artery infarction (LAI). Twelve (30%) had CI, in 9 (23%) it was symptomatic and in 3 (8%) silent. Seven (58%) had LAI ± LI. Eight (67%) had multiple CI. Two died from brainstem CI and 6 were dependent at 1 year. Patients with LAI might develop posterior circulation CI more frequently than those with LI only. CI is a common complication of TBM locally, with LAI and multiple CI being common. Two thirds of TBM patients complicated by CI had poor prognosis despite adjunctive dexamethasone treatment.

Tuberculous cerebrovascular disease: A review

“…They also emphasise, as do others 12,19 that small infarcts are often clinically silent, and that in some cases symptoms are transient, which they attribute to ischaemia rather than infarction, perhaps due to vessel spasm. Bharucha et al 41 go as far as to suggest that few cases of TBM with focal neurology have a vascular explanation, but this view is not widely held.…”

British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children

“…81 Infarctions as a result of ongoing vasculitis or tuberculoma are found in approximately 20% of patients at presentation. 80,82,83 More than 70% develop tuberculoma during treatment, although the majority are asymptomatic. 23 Infarctions most commonly involve the basal ganglia and the territories of the medial striate and thalamoperforating arteries.…”

Paradoxical Infarct in Tuberculous Meningitis: A Case Report

“…MRI has shown infarcts in up to 57% of the patients with TBM (9). Despite this incidence of infarct, 25% to 58% of the cases of TBM infarcts were reported to be asymptomatic (9,10). In up to 75% of the patients, the infarcts are located in the "tubercular zone" which comprises of the head caudate nucleus, the anteriomedial thalami, the anterior limb and genu of the internal capsule.…”