Cerebrovascular Complication in Tuberculous Meningitis

ABSTRACT

BACKGROUND: Cerebral infarction as a complication of tuberculous meningitis (TBM) is not uncommon, but has been rarely reported. The purposes of this study were to evaluate the clinical characteristics of cerebral infarction secondary to TBM and investigate the predictive values for cerebral infarction in patients with TBM. METHODS: We prospectively collected patients with TBM for 24 months. Patients were divided into two groups, either patients with stroke or without stroke. We compared the demographic features, clinical, laboratory, and neuroradiologic findings between the two groups. We classified the stroke subtype with neuroimaging findings. RESULTS: The 26 patients were diagnosed as TBM, and 6 patients had complications with cerebral infarction. The neutrophil percentage in the cerebrospinal fluid (CSF) leukocyte were significantly higher in patients with stroke than in patients without stroke (p=0.0098). On initial CT scan, meningeal enhancement was found in 9 patients, and 4 of them complicated with stroke. However, there were no significant differences in the other clinical and laboratory features such as demographic features, interval between meningitis onset time and treatment initiation time, peripheral white blood cell count, and CSF findings. In six patients with stroke, lacunar infarctions and non-lacunar territorial infarctions were found in 3 patients, respectively. In territorial non-lacunar infarction patients, one patient died due to herniation. CONCLUSIONS: We suggest that the possibility of cerebral infarction under the treatment of TBM should be considered, when the patient shows focal neurologic signs, meningeal enhancement on the CT scan and sustained polymorphic CSF pleocytosis.