Tuberculous Meningitis Complicated With Deep Sylvian Cerebral Infarction: About an Immunocompetent Patient With HIV-AIDS

Abstract

INTRODUCTION Neuromeningeal tuberculosis is the most common form of extra-pulmonary tuberculosis in developing countries. It is the most serious form of Mycobacterium tuberculosis infection. Vascular complications of tuberculous meningitis involve functional prognosis of patients.OBSERVATION In our daily practice, we frequently encounter cases of cerebral infarction associated with neuromeningeal tuberculosis in the infectious etiological balance. We report the case of an HIV immunocompetent patient hospitalized for neuromeningeal tuberculosis complicated with ischemic stroke. It was a 39-year-old patient, right-handed, admitted to the Neurology department of University Hospital of Cocody in whom the diagnosis of neuromeningeal tuberculosis was retained. She received treatment for tuberculosis in emergency. On the seventh day of hospitalization, she suddenly presented with a massive motor deficit of the left hemibody. The MRI performed was compatible with meningoencephalitis associated with recent deep right Sylvan ischemia foci. The evolution was marked by partial recovery of the left hemiplegia, right retro-bulbar neuritis, and iatrogenic hepatic cytolysis.COMMENTS Tuberculous meningitis remains today one of the most serious neurological conditions involving the vital and functional prognosis of patients. Association of cerebral infarction and tuberculous meningitis is of variable occurrence. There are reported cases in which cerebral infarction is a complication of tuberculous meningitis. On the other hand, the discovery of tuberculous meningitis can be observed in the assessment of a cerebral infarction in young subjects. Tuberculous meningovascularitis remains a rare condition in immunocompetent patients for HIV-AIDS. It results from arterial occlusion by thrombosing and obliterating endarteritis. It represents a medical emergency requiring starting anti-tuberculosis treatment. The evolution depends on the precocity of the diagnosis and the speed of treatment.CONCLUSION The sudden appearance of a neurological deficit in à patient with tuberculous meningitis even under specific treatment should suggest an ischemic stroke, especially if the symptomatology respects an anatomo-functional vascular systematization.