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Published on: September 5, 2017

Cerebral infarction as the first presentation of tuberculosis in an infant: a case report

Farid Radmanesh1, Farideh Nejat, Mostafa El Khashab

  • 1Department of Neurosurgery, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Journal of Microbiology, Immunology, and Infection = Wei Mian Yu Gan Ran Za Zhi
|February 5, 2011
PubMed

Insights

Tuberculosis in a child presented unusually with stroke-like symptoms and hydrocephalus. Diagnosis was confirmed via peritoneal biopsy and cerebrospinal fluid analysis, leading to successful treatment with antitubercular therapy.

Area of Science:

  • Neurology
  • Pediatrics
  • Infectious Diseases

Background:

  • Pediatric stroke and hydrocephalus require thorough etiological investigation.
  • Tuberculosis (TB) can present with diverse neurological manifestations, often including constitutional symptoms.

Observation:

  • A child presented with acute hemiparesis and seizures, initially suspected as an ischemic event.
  • Progressive hydrocephalus necessitated ventriculoperitoneal shunting, which later became infected.
  • Peritoneal thickening and granulomatous reaction on biopsy, alongside positive cerebrospinal fluid PCR, confirmed disseminated tuberculosis.

Findings:

  • The case highlights an atypical presentation of tuberculosis (TB) in a child, manifesting initially as cerebral infarction and hydrocephalus.
  • Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) and peritoneal biopsy were crucial for diagnosing TB.
  • The patient showed significant recovery after initiating antitubercular therapy and shunt revision.

Implications:

  • This case underscores the importance of considering disseminated tuberculosis in pediatric patients with unexplained neurological deficits and hydrocephalus, even without typical systemic symptoms.
  • It emphasizes the diagnostic utility of peritoneal biopsy and CSF PCR in complex cases.
  • Early diagnosis and appropriate antitubercular treatment are vital for favorable neurological outcomes in such presentations.

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