A Case Report of Acute Ischaemic Stroke Associated with T​uberculous Meningitis

Tuberculous meningitis (TBM) is a severe form of tuberculosis (TB) that affects the meninges, frequently causing major neurological problems. Timely diagnosis and care are crucial to avoid unfavourable consequences, particularly in vulnerable populations.

This case report aims to highlight the diagnostic problems and management complications of TBM, especially when combined with rare neurological events such as acute ischaemic stroke (AIS).

An 84-year-old female presented with disorientation, seizures, aphasia and hemiparesis. The initial imaging revealed normotensive hydrocephalus and bilateral delta activity on the electroencephalogram (EEG). Despite anti-fungal treatment, CT imaging revealed widespread inflammatory alterations. Sputum and cerebrospinal fluid (CSF) tests were done and revealed the presence of Mycobacterium tuberculosis. MRI indicated several acute lesions, which are symptomatic of TBM.

The patient developed AIS, a relatively rare complication of TBM. Treatment was initiated with a combination of anti-TB drugs and corticosteroids. While corticosteroids reduced inflammation and mortality risk, their potential to contribute to long-term disability was noted as an area of concern.

This case underscores the critical role of MRI in the early detection of TBM-related complications. Although corticosteroids improve short-term outcomes, their impact on long-term disability necessitates further research. Effective management strategies tailored to vulnerable populations are essential to improve the prognosis of TBM patients.