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Extensive Vasculitis in Tuberculous Meningitis
Rajesh Verma1, Rajarshi Chakraborty1
1Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India.
Abstract:
Tuberculous meningitis causes substantial morbidity and mortality in tropical countries. The various complications reported are hydrocephalus, vasculitic infarcts, tuberculomas, abscesses, and optochiasmatic arachnoiditis. Vasculitis in tuberculosis is basically at the level of lenticulostriate arteries supplying the basal ganglia and terminal cortical branches. In this case report, we present a rare case of tuberculous meningitis with extensive vasculopathy. During hospitalization, she developed acute onset right-sided classical hemiplegia with the inability to speak due to left internal carotid artery occlusion on imaging. The cerebrospinal fluid depicted very high protein levels. The exact pathogenesis of such extensive involvement in tuberculous meningitis substantiates the need for further studies.
Insights
Tuberculous meningitis can cause severe complications like stroke. This case highlights extensive vasculopathy, leading to stroke and speech loss, emphasizing the need for further research into its pathogenesis.
Area of Science:
- Neurology
- Infectious Diseases
- Vascular Medicine
Background:
- Tuberculous meningitis (TBM) is a significant cause of death and disability, particularly in tropical regions.
- Common complications include hydrocephalus, infarcts, tuberculomas, and arachnoiditis.
- Vasculitis in TBM typically affects the lenticulostriate arteries and terminal cortical branches.
Observation:
- This report details a rare case of TBM presenting with extensive vasculopathy.
- The patient experienced sudden right-sided hemiplegia and aphasia.
- Imaging revealed occlusion of the left internal carotid artery.
Findings:
- Cerebrospinal fluid analysis showed markedly elevated protein levels.
- The extensive vascular involvement suggests a severe inflammatory response.
- The patient's presentation indicates a direct link between TBM and major arterial occlusion.
Implications:
- This case underscores the potential for severe cerebrovascular complications in TBM.
- Understanding the pathogenesis of TBM-associated vasculopathy is crucial for effective treatment.
- Further research is warranted to elucidate the mechanisms behind extensive vasculopathy in TBM.
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