好色先生

好色先生

Explore the latest content from across our publications
Join The AAN

Log In

Forgot Password?
Create New Account

Loading... please wait

Abstract Details

Stroke Due to Tuberculous Meningitis: A Report of Six Cases
Infections/AIDS/Prion Disease
P04 - (-)
014
BACKGROUND: Central nervous system vasculitis is a complication of tuberculous meningitis and is consequent to inflammation of the cerebral vessel walls. Brain ischemia is caused by narrowing of arteries in the circle of Willis.
DESIGN/METHODS: We reviewed the files of patients diagnosed with tuberculous meningitis between 2004 and 2012 and selected patients with clinical and radiological evidence of cerebral vasculitis. The following information was retrieved: age, sex, clinical presentation, laboratory findings and treatments.
RESULTS: Six patients met the criteria: for men and two women. Tuberculous meningitis diagnosis was established by a positive CSF culture in all of the patients. Median age at diagnosis was 36.5 years. All patients were previously healthy except for a patient with HIV. Median time between meningeal symptoms and antituberculous treatment initiation was 16 days. Median time between treatment initiation and ischemic symptoms was of 15.5 days. Vasculitis was diagnosed by angioresonance imaging in all patients. Transcranial Doppler ultrasound and cerebral angiography were performed afterwards. Symptoms associated with stroke were seizures (n=4), altered sensorium (n=3) and focalizing signs (n=4). The most affected vascular territories were both middle cerebral arteries in the M1 and M2 portions and the perforating thalamic arteries. Treatment included an increase in the steroid oral dose and even cyclophosphamide boluses in one case. One patient died because of a malignant stroke. Another patient was lost during follow-up. The remaining patients are alive with sequelae (cognitive decline, dysphasia, paresis and altered gait).
CONCLUSIONS: Tuberculous CNS vasculitis usually presents in young healthy patients and after the initiation of adequate antituberculous treatment. It represents a clinical chalenge and usually leaves serious sequelae.
Authors/Disclosures
Maria Del Mar Saniger-Alba, MD (Neurocon)
PRESENTER 		No disclosure on file
Maria Alejandra Gonzalez Duarte, MD, FAAN (NYU Dysautonomia Center) Dr. Gonzalez Duarte has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alnylam. Dr. Gonzalez Duarte has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra Zeneca. Dr. Gonzalez Duarte has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alnylam . The institution of Dr. Gonzalez Duarte has received research support from Pfizer.
Guillermo S. Garcia-Ramos, MD No disclosure on file
Elizabeth M. Berry-Kravis, MD, PhD (Rush University Medical Center) The institution of Dr. Berry-Kravis has received research support from NIH. The institution of Dr. Berry-Kravis has received research support from Ionis. The institution of Dr. Berry-Kravis has received research support from Zynerba. The institution of Dr. Berry-Kravis has received research support from Roche. The institution of Dr. Berry-Kravis has received research support from CDC. The institution of Dr. Berry-Kravis has received research support from FRAXA Research Foundation. The institution of Dr. Berry-Kravis has received research support from GeneTx. The institution of Dr. Berry-Kravis has received research support from Angelman Syndrome Foundation. The institution of Dr. Berry-Kravis has received research support from Acadia. The institution of Dr. Berry-Kravis has received research support from Ultragenyx. The institution of Dr. Berry-Kravis has received research support from Mallinckrodt. The institution of Dr. Berry-Kravis has received research support from Together Strong Foundation. The institution of Dr. Berry-Kravis has received research support from Zevra. The institution of Dr. Berry-Kravis has received research support from Taysha. The institution of Dr. Berry-Kravis has received research support from Tetra. The institution of Dr. Berry-Kravis has received research support from Neuren.
No disclosure on file