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Stroke in tuberculous meningitis

Usha Kant Misra1, Jayantee Kalita, Pradeep Kumar Maurya

  • 1Department of Neurology, Sanjay Gandhi PGIMS, Lucknow, India. drukmisra@rediffmail.com

Journal of the Neurological Sciences
|January 29, 2011
PubMed

Insights

Stroke is common in tuberculous meningitis (TBM), often affecting the basal ganglia due to arterial involvement. Further research is needed on treatments like aspirin to reduce stroke incidence in TBM patients.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Stroke is a frequent complication of tuberculous meningitis (TBM), occurring in 15-57% of patients, particularly those with advanced disease.
  • Strokes in TBM can be asymptomatic and are often multiple, bilateral, and located in the basal ganglia, a region known as the 'tubercular zone'.

Purpose of the Study:

  • To investigate the frequency, location, and potential causes of stroke in patients with tuberculous meningitis.
  • To review the diagnostic utility of MRI and other imaging modalities in detecting stroke in TBM.
  • To explore the role of inflammatory cytokines and prothrombotic states in TBM-related stroke.

Main Methods:

  • Review of existing literature and case studies on stroke in TBM.
  • Analysis of imaging findings, particularly MRI (DWI, T2, FLAIR), angiography, and autopsy results.
  • Examination of pathological mechanisms including arteritis, cytokine involvement (TNFα, VEGF, MMPs), and prothrombotic factors.

Main Results:

  • Most TBM strokes are bilateral, multiple, and located in the basal ganglia ('tubercular zone'), affecting arteries like the medial striate, thalamotuberal, and thalamostriate.
  • Cortical strokes can also occur due to involvement of major cerebral arteries (MCA, ACA, PCA, ICA, basilar).
  • Autopsy studies indicate arteritis is more common than infarction, with cytokines and prothrombotic states implicated in pathogenesis.

Conclusions:

  • Stroke is a significant neurological complication of TBM, with characteristic patterns and locations.
  • While corticosteroids and antitubercular therapy may reduce mortality, their specific impact on stroke reduction in TBM requires further investigation.
  • The role of aspirin in reducing stroke in TBM warrants additional research.

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