Chapter 2.3 - Tuberculosis Meningitis

Summary

Stroke is a devastating complication of tuberculous meningitis (TBM) and it is associated with higher morbidity and mortality. The common pathologies of stroke in TBM include basal exudate induced inflammatory vasospasm, vasculitis, thrombosis and occlusion of large intracerebral arteries and their penetrating branches. Since TBM associated stroke occurs in a chronic and advanced stage patient, its diagnosis can be missed clinically. Hence, radiologic investigations advance the diagnostic accuracy. We report a case of a 28-year-old right-handed black women who presented to the emergency department with a sudden onset dizziness, postural imbalance, falls and right-side visual obscuration of 1-day duration. She had non-specific constitutional symptoms since the past 3 weeks and recently she got an empiric therapy for pyogenic meningitis without improvement. At presentation, she had fever and meningismus. On neurologic exam, she was lethargic with right side visual field defect and left side cerebellar signs. Her brain magnetic resonance imaging showed multiple posterior circulation acute infarcts. Cerebrospinal fluid analysis showed lymphocytic pleocytosis with increased protein and low glucose, A Gene Xpert test from her cerebrospinal fluid was positive for Mycobacterium tuberculosis. Aspirin and antituberculosis medication with steroid was started and after 4 weeks, she was discharged improved. Stroke is a rare but a fatal complication of TBM. Therefore, early recognition and timely initiation of empiric treatment is vital to avoid disease progression to an advanced stage and prevent such grave complication of TBM