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Tuberculous meningitis (TBM) can cause severe neurological symptoms and stroke. Early identification through imaging findings like hydrocephalus and basal meningeal enhancement is crucial for prompt treatment and recovery.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Tuberculous meningitis (TBM) is a severe form of extrapulmonary tuberculosis, often presenting with subtle or atypical neurological symptoms.
  • Prompt diagnosis and treatment are critical to prevent severe morbidity and mortality associated with TBM.

Observation:

  • A 17-year-old male presented with a 20-day history of progressive neurological deterioration, including vomiting, abdominal pain, weight loss, headache, fever, dysarthria, somnolence, urinary incontinence, slurred speech, weakness, and inability to walk.
  • Neurological examination revealed diminished visual acuity and diplopia. Head CT showed acute hydrocephalus. CSF analysis indicated pleocytosis, hypoglycorrhachia, and hyperproteinorrachia.
  • Brain MRI revealed leptomeningitis, basal ganglia infarcts, and basal meningeal enhancement, strongly suggesting TBM. The patient's Thwaites score was -5.

Findings:

  • The patient demonstrated a positive response to antituberculous treatment and dexamethasone.
  • At a 2-year follow-up, the patient remained symptom-free, indicating successful management.
  • Key imaging findings suggestive of TBM include hydrocephalus, basal meningeal enhancement, and basal ganglia infarcts, often referred to as the 'TBM triad'.

Implications:

  • Stroke is a common complication of TBM and can lead to long-term neurological deficits.
  • The 'TBM triad' on brain imaging is a valuable tool for the rapid identification of probable TBM, especially in endemic areas.
  • Early recognition and initiation of appropriate therapy can significantly improve patient outcomes in TBM.