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Tuberculous cerebrovascular disease: a review

G Alistair Lammie1, Richard H Hewlett, Johan F Schoeman

  • 1Department of Pathology, Cardiff University, Heath Park, Cardiff CF144XN, UK. lammiega@cf.ac.uk

The Journal of Infection
|July 29, 2009
PubMed

Insights

Tuberculous meningitis (TBM) frequently causes serious cerebrovascular complications like brain infarcts. Current treatments are often ineffective, highlighting the need for better prevention strategies.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Vascular Medicine

Background:

  • Cerebrovascular complications are a significant challenge in tuberculous meningitis (TBM).
  • These complications manifest diversely and can worsen during early treatment.
  • Brain infarcts are common, often presenting as multiple or bilateral lesions.

Purpose of the Study:

  • To review the pathogenetic aspects of tuberculous cerebrovascular disease.
  • To explore potential targets for future prevention strategies.

Main Methods:

  • Review of existing literature on TBM vasculopathy.
  • Analysis of imaging findings, particularly Magnetic Resonance Imaging (MRI).
  • Discussion of proposed mechanisms including inflammation, vasospasm, and intimal disease.

Main Results:

  • MRI reveals brain infarcts in TBM, often affecting middle cerebral artery territories.
  • Vessel pathology is linked to inflammatory exudates, with infiltrative and proliferative changes observed.
  • The roles of luminal thrombosis, vasospasm, and intimal disease in TBM-related stroke are under investigation.
  • Anti-tuberculous chemotherapy shows limited efficacy in preventing vascular issues, suggesting immune involvement.

Conclusions:

  • TBM vasculopathy is complex, with unclear contributions from various pathological processes.
  • Current anti-TBM therapies may not adequately prevent vascular complications.
  • Further research into molecular pathogenesis is crucial for developing targeted preventive measures, including the potential role of corticosteroids.

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