Miliary brain tuberculomas and tuberculous meningitis presenting with stroke

Area of Science:

• Neurology
• Infectious Diseases
• Pediatrics

Background:

• Tuberculosis (TB) can manifest with severe neurological complications, including tuberculous meningitis (TBM).
• TBM is an uncommon but highly fatal presentation of Mycobacterium tuberculosis infection.
• Prompt recognition and management are critical for improving patient outcomes.

Observation:

• A 6-year-old female presented with left hemiparesis, indicative of a neurological deficit.
• Cerebral imaging revealed an ischemic stroke, severe leptomeningitis, miliary tuberculomas, and hydrocephalus.
• Pulmonary micronodules suggested disseminated tuberculosis.

Findings:

• Cerebrospinal fluid (CSF) analysis confirmed meningitis with a positive Mycobacterium tuberculosis polymerase chain reaction.
• The combination of neurological symptoms, imaging findings, and microbiological results confirmed tuberculous meningitis with stroke.
• The case highlights the diverse and severe neurological manifestations of TB.

Implications:

• This case underscores the importance of considering TBM in the differential diagnosis of pediatric stroke and meningitis, even in the absence of typical pulmonary findings.
• Aggressive diagnostic workup, including CSF analysis and neuroimaging, is essential for timely diagnosis.
• Effective management strategies for TBM involving anti-tuberculosis therapy and supportive care are crucial for mitigating severe neurological sequelae.