Related Experiment Video
Updated: Feb 21, 2026
Point of Care Transcranial Color-Coded Duplex Ultrasound of the Middle Cerebral Artery
Published on: August 9, 2024
Evaluation of cerebral arterial and venous system in tuberculous meningitis
Jayantee Kalita1, Rajesh K Singh1, Usha K Misra1
1Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical sciences, Raebareily Road, 226014 Lucknow, UP, India.
Background:
Central nervous system infection especially pyogenic results in cerebral venous sinus thrombosis. Tuberculous meningitis (TBM) although associated with infarctions but there is no comprehensive study evaluating the role of CVST contributing in infarction.
Purpose:
To evaluate cerebral arterial and venous system using MR angiography (MRA) and MR venography (MRV) in TBM, and correlate with clinical and MRI findings.
Materials And Methods:
Consecutive patients with TBM were evaluated clinically and their consciousness was assessed by using Glasgow Coma scale. Cerebrospinal fluid analysis was done. Patients were subjected to MRI, MRA and MRV studies. The severity of TBM was categorized as grades I to III. Presence of infarction on MRI and its cause as arterial or venous was noted based on MRA and MRV abnormalities.
Results:
Twenty-six patients were included whose median age was 23 years. Seven (26.9%) patients had stage I, 12 (46.2%) stage II and 7 (26.9%) stage III TBM. MRI revealed infarction in 13 (50%) patients and were in tubercular zone (caudate, lentiform nuclei, anterior limb and genu of internal capsule, and anterior thalamus) in all except one. MRA was abnormal in 11/25 (42.3%) patients; 7 had middle cerebral artery, 2 both posterior cerebral artery and middle cerebral artery, and 2 had narrowing of all intracranial vessels. MRV however did not reveal any evidence of CVST although revealed variation in normal anatomy in 14 (53.8%) patients, commonest being hypoplastic transverse sinus.
Conclusion:
In TBM, infarction occurs in 50% patients, and is of arterial in origin. Cerebral venous system is usually spared in TBM.
Insights
Tuberculous meningitis (TBM) causes arterial infarction in 50% of patients, with the cerebral venous system typically unaffected. This study used MRA and MRV to evaluate TBM patients and their imaging findings.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Central nervous system infections, particularly pyogenic ones, are known to cause cerebral venous sinus thrombosis (CVST).
- Tuberculous meningitis (TBM) is associated with infarctions, but the specific role of CVST in TBM-related infarction requires comprehensive evaluation.
Purpose of the Study:
- To assess the cerebral arterial and venous systems in TBM patients using MR angiography (MRA) and MR venography (MRV).
- To correlate imaging findings with clinical and MRI results in TBM.
Main Methods:
- Clinical evaluation and Glasgow Coma Scale assessment of consecutive TBM patients.
- Cerebrospinal fluid analysis, MRI, MRA, and MRV studies were performed.
- TBM severity was graded (I-III), and infarction causes (arterial vs. venous) were determined based on MRA/MRV findings.
Main Results:
- Fifty percent of TBM patients (13/26) exhibited infarction, predominantly in the basal ganglia and internal capsule.
- MRA revealed abnormalities in 42.3% of patients, indicating arterial involvement (e.g., middle cerebral artery stenosis).
- MRV showed no evidence of CVST, though anatomical variations like hypoplastic transverse sinuses were noted in 53.8%.
Conclusions:
- Infarction in TBM is common (50%) and primarily of arterial origin.
- The cerebral venous system appears to be largely spared in TBM.
Related Concept Videos
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
01:27Assessment of the Cardiovascular System III: Palpation
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above...
01:26Pulmonary Tuberculosis IV
Several diagnostic approaches are used to detect TB. The conventional method is the Tuberculin Skin Test (TST), also known as the Mantoux test. However, this method has...