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A Model for Epilepsy of Infectious Etiology using Theiler's Murine Encephalomyelitis Virus
Published on: June 23, 2022
Seizure heralding tuberculous meningitis
Francesco Brigo1, Harald Ausserer, Giulio Zuccoli
1Department of Neurological, Neuropsychological, Morphological and Movement Sciences. Section of Clinical Neurology. University of Verona, Italy, Department of Neurology, Franz Tappeiner Hospital, Merano, Italy.
Epileptic Disorders : International Epilepsy Journal with Videotape
|September 4, 2012
Summary
Tuberculous meningitis can present with seizures, even without initial MRI abnormalities. Contrast-enhanced MRI is crucial for diagnosing meningitis in first-time seizures, especially with suspected central nervous system infections.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Seizures are common in tuberculous meningitis.
- Tuberculous meningitis can present insidiously, with seizures as an early symptom.
- Initial neuroimaging may not reveal abnormalities.
Purpose of the Study:
- To highlight seizures as a presenting symptom of tuberculous meningitis.
- To emphasize the utility of contrast-enhanced MRI in diagnosing tuberculous meningitis.
- To introduce the concept of 'heraldic seizures' in this context.
Main Methods:
- Case report of a patient with generalized tonic-clonic seizure as the initial symptom of tuberculous meningitis.
- Initial magnetic resonance imaging (MRI) without contrast.
- Follow-up MRI with gadolinium administration.
Main Results:
- The initial MRI showed no abnormalities.
- Follow-up MRI with contrast revealed meningeal enhancement, indicative of tuberculous meningitis.
- The seizure was the presenting symptom preceding clear MRI findings.
Conclusions:
- Seizures can be the initial manifestation of tuberculous meningitis, even without apparent intracerebral lesions on initial MRI.
- Contrast-enhanced brain MRI is recommended for the workup of first seizures, particularly in patients with suspected central nervous system infections.
- The term 'heraldic seizure' may be useful for retrospectively classifying seizures that precede the full clinical picture of an underlying insult.
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