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Cerebral infarcts complicating tuberculous meningitis
K H Chan1, R T F Cheung, R Lee
1Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, SAR, China. koonhochan@hotmail.com
Cerebrovascular Diseases (Basel, Switzerland)
|May 3, 2005
Summary
Cerebral infarction (CI), a stroke complication of tuberculous meningitis (TBM), affected 30% of patients. Many experienced large artery infarction and multiple strokes, often leading to poor outcomes despite treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Cerebral infarction (CI) is a significant complication of tuberculous meningitis (TBM), potentially leading to stroke.
- CI in TBM can be asymptomatic or symptomatic, impacting patient prognosis.
Purpose of the Study:
- To investigate the incidence, patterns, and outcomes of cerebral infarction in patients with tuberculous meningitis.
- To classify CI types, including lacunar infarction (LI) and large artery infarction (LAI), and assess their association with clinical presentation and prognosis.
Main Methods:
- Retrospective study of 40 TBM patients.
- Initial CT brain scan, follow-up CT/MRI at 3 months, and urgent CT for deterioration.
- Classification of CI into LI and LAI, noting multiplicity and location.
Main Results:
- Twelve (30%) patients had CI; 9 (23%) were symptomatic, 3 (8%) silent.
- Large artery infarction (LAI) +/- LI occurred in 7 (58%) patients.
- Multiple CI (8/67%) and posterior circulation involvement were observed.
- Two patients died from brainstem CI; 6 were dependent at 1 year.
Conclusions:
- Cerebral infarction is a common complication of TBM, frequently involving large arteries and multiple sites.
- Patients with LAI may have a higher risk of posterior circulation CI.
- Two-thirds of TBM patients with CI experienced poor outcomes, even with dexamethasone therapy.