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Paradoxical infarct in tuberculous meningitis: a case report

Hiroshi Morioka1, Shuuichi Matsumoto, Eiji Kojima

  • 1Division of Infectious Disease, Tokyo Metropolitan Komagome Hospital, Japan. h-morioka@cick.jp

Internal Medicine (Tokyo, Japan)
|April 17, 2012
PubMed

Insights

This rare case highlights tuberculous meningitis (TBM) presenting with recurrent infarcts. A paradoxical reaction to anti-tuberculous therapy (ATT) may explain new brain lesions despite treatment.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Tuberculous meningitis (TBM) is a severe form of tuberculosis affecting the central nervous system.
  • Neurological complications, including stroke, can occur in TBM patients.

Observation:

  • A 78-year-old woman presented with fever and hemiparesis, revealing infarcts on MRI.
  • Despite initial treatment for miliary tuberculosis and TBM with anti-tuberculous therapy (ATT) and prednisolone, she developed recurrent infarcts.
  • The new infarcts appeared in atypical locations five weeks after commencing ATT.

Findings:

  • The patient was diagnosed with miliary tuberculosis and tuberculous meningitis.
  • Recurrent ischemic events were observed despite appropriate anti-tuberculous therapy.
  • Cerebral infarcts occurred in unusual patterns, suggesting complex pathophysiology.

Implications:

  • This case suggests a paradoxical reaction to anti-tuberculous therapy as a potential cause for new infarcts in TBM.
  • Understanding atypical presentations and treatment responses in TBM is crucial for patient management.
  • Further research into the mechanisms of paradoxical reactions in TBM-related stroke is warranted.

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