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Cerebral infarction pattern in tuberculous meningitis.

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Cerebral infarction in tuberculous meningitis (TBM) primarily affects perforator and cortical arteries, not solely the "TB zone" or "ischaemic zone". This finding impacts understanding of TBM

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Tuberculous meningitis (TBM) is a severe condition with high morbidity and mortality.
  • Understanding the patterns of cerebral infarction in TBM is crucial for patient outcomes.

Purpose of the Study:

  • To re-evaluate the concepts of
  • TB zone
  • and
  • ischaemic zone
  • in relation to cerebral infarction in TBM.
  • To assess the prevalence of cerebral infarction, vasculitis, and vasospasm in TBM patients.

Main Methods:

  • Retrospective analysis of 51 TBM patients recruited between 2009 and 2014.
  • Neuroimaging (MRI/CT) was used to identify and classify cerebral infarcts based on arterial supply and Hsieh's classification.
  • Findings of vasculitis and vasospasm were also recorded.

Main Results:

  • Cerebral infarction was present in 67% (34/51) of TBM patients.
  • Infarcts predominantly involved perforator and cortical branches, with 59% showing involvement in both
  • TB zone
  • and
  • ischaemic zone
  • .
  • Vasculitis was observed in 37% and vasospasm in 15% of patients. Leptomeningeal enhancement correlated significantly with cerebral infarction (85%).

Conclusions:

  • Cerebral infarction in TBM is complex, involving multiple arterial territories, particularly perforators and cortical branches.
  • The traditional
  • TB zone
  • and
  • ischaemic zone
  • classification may not fully capture the infarct patterns in TBM.
  • Findings highlight the importance of comprehensive neuroimaging in managing TBM complications.