Tuberculous Meningitis Complicated by Communicating Hydrocephalus and Lacunar Infarcts: A Case Report

Area of Science:

• Neurology
• Infectious Diseases
• Critical Care Medicine

Background:

• Tuberculous meningitis (TBM) poses significant diagnostic and therapeutic challenges, particularly without early microbiological confirmation.
• Central nervous system tuberculosis (CNS-TB) can lead to severe complications and neurological deficits.

Observation:

• A previously healthy 32-year-old female presented with fever, headache, and altered mental status, initially with negative CSF cultures.
• Cerebrospinal fluid (CSF) analysis suggested TBM, with MRI revealing meningeal enhancement and vasculitic changes.
• The patient experienced rapid neurological decline, requiring external ventricular drainage and ventriculoperitoneal (VP) shunting for hydrocephalus.

Findings:

• Despite initial negative CSF cultures, Mycobacterium tuberculosis was later confirmed.
• The patient developed hyponatremia, likely due to SIADH, and experienced multiple lacunar infarcts indicative of vasculitis.
• She responded well to empirical anti-tuberculous therapy (ATT), corticosteroids, and multidisciplinary care.

Implications:

• Early clinical recognition and prompt empirical therapy are vital for TBM management, even with delayed microbiological confirmation.
• Timely neurosurgical intervention for hydrocephalus and proactive management of complications like hyponatremia are crucial for reducing morbidity.
• Multidisciplinary care significantly improves neurological recovery and patient outcomes in TBM.