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Updated: Nov 9, 2025
A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
Published on: August 18, 2015
Risk factors for ischemic stroke in children with tuberculous meningitis
Regan S Solomons1, Sarel T Nieuwoudt2, James A Seddon2,3
1Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa. regan@sun.ac.za.
Insights
Tuberculous meningitis frequently causes stroke in children. Young age, seizures, and hydrocephalus are key risk factors for stroke at admission and during treatment, highlighting a potential window for preventive therapy.
Area of Science:
- Pediatric Neurology
- Infectious Diseases
- Cerebrovascular Medicine
Background:
- Cerebrovascular complications, particularly stroke, are a significant concern in pediatric tuberculous meningitis (TBM).
- Understanding the clinical factors associated with stroke is crucial for timely diagnosis and intervention in affected children.
Purpose of the Study:
- To identify clinical factors associated with stroke at the time of admission in children diagnosed with TBM.
- To determine factors predicting the development of stroke during treatment among children initially free of stroke.
Main Methods:
- A cohort of 474 children with definite or probable TBM was analyzed using prospectively collected data from 1985 to 2005.
- Stroke was defined as hemiparesis or radiological arterial ischemic infarction.
- Clinical data, including age, seizures, hydrocephalus, and cerebrospinal fluid (CSF) cell counts, were assessed for association with stroke.
Main Results:
- At admission, 71.5% of children presented with stroke. Factors associated with stroke included age under 3 years, convulsions, and hydrocephalus.
- Among children without stroke at admission (n=135), 24.4% developed stroke within one month.
- Predictors for stroke development during treatment were similar, including young age, convulsions, abnormal CSF cell counts, and hydrocephalus.
Conclusions:
- A substantial proportion of children with TBM experience stroke at admission.
- A significant percentage of initially stroke-free children develop stroke within the first month, indicating a critical window for potential preventive interventions.
Purpose:
Cerebrovascular complications are commonly observed in children with tuberculous meningitis. We aimed to determine which clinical factors were associated with stroke at admission in children with tuberculous meningitis and, in children stroke-free at admission, which factors were associated with development of stroke on treatment.
Methods:
We analysed a cohort of 474 children diagnosed with 'definite' and 'probable' tuberculous meningitis, with prospectively collected data, at Tygerberg Hospital, Cape Town, South Africa from 1985 to 2005. We considered either hemiparesis or radiological arterial ischemic infarction as evidence of stroke.
Results:
At admission, 339 (71.5%) children presented with stroke. Features associated with stroke at admission included age <3 years (odds ratio (OR) 3.70; 95% confidence interval (CI): 2.44-5.63; p < 0.01), convulsions (OR: 2.25; 95% CI: 1.46-3.45; p < 0.01) and hydrocephalus (OR: 1.63; 95% CI: 1.05-2.53; p = 0.03). In the group of children without stroke at admission (n = 135), 33 (24.4%) developed stroke by 1 month. Similar factors predicted stroke and included age <3 years (OR: 2.60; 95% CI: 1.17-5.80; p = 0.02), convulsions (OR: 2.25; 95% CI: 1.46-3.45; p < 0.01), CSF cell count <10 or >500/L (OR: 3.12; 95% CI: 1.03-9.43; p = 0.04) and hydrocephalus (OR: 2.99; 95% CI: 1.30-6.89; p = 0.01).
Conclusion:
A large proportion of children with tuberculous meningitis present with stroke at admission. Of those with no evidence of stroke at admission, a quarter develop stroke by 1 month, suggesting that there could be a brief window in which to give preventive therapy.
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