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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
Summary
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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